Two years after approving a major plan to combat HIV/AIDS, the government is still sending mixed messages about anti-retroviral drugs.
A lawsuit to be heard in Cape Town soon promises to bring to a head the continuing controversy over those drugs, a life-and-death matter for the more than 6.5 million South Africans -- out of a population of 45 million -- living with the disease.
The Treatment Action Campaign, an advocacy group representing people with HIV/AIDS, is suing Dr. Matthias Rath, a German physician and vitamin salesman, for defamation.
Rath has claimed that anti-retroviral drugs are toxic and that the advocacy group, which led a successful campaign to make President Thabo Mbeki's government provide the drugs in the public health system, is helping the pharmaceutical industry.
The Treatment Action Campaign, which in the past has successfully sued multinational drug companies over their prices, rejects the claim. It says Rath is a charlatan who has had problems selling his vitamins in other countries and is now dangerously misleading patients in a nation with one of the world's largest AIDS caseloads.
"He's known for guerrilla marketing of his products under the guise of an anti-imperialist agenda," said Fatima Hassan, a lawyer representing the group in the lawsuit. "The same campaign has been used in other countries."
Rath has confirmed conducting a "clinical pilot study" on people with full-blown AIDS in Khayelitsha, a poor township near Cape Town. In a South African newspaper advertisement in April, Rath asserted that vitamin treatments had reversed the course of the disease.
"There is an alternative to [anti-retroviral] drugs, and it is working," 29-year-old "Marieta" testified in the advertisement, which said that the vitamins had reversed tumor-like swelling in her lymph nodes. "I am the living proof that nutrients work."
The lawsuit might seem like a macabre sideshow to the global fight against HIV/AIDS were it not for the fact that Rath appears to enjoy the tacit approval of South Africa's top health official.
Minister of Health Manto Tshabalala-Msimang said recently that she would distance herself from Rath only "if it can be demonstrated that the vitamin supplements he is prescribing are poisonous for people infected with HIV."
Anti-retroviral drugs are a centerpiece of the government's HIV/AIDS plan, but Tshabalala-Msimang has been widely criticized for presenting traditional medicine and foods such as lemon, garlic and olive oil as alternative treatments.
Setting up what Hassan calls a "false dichotomy," she often speaks of good nutrition as a replacement for pharmaceuticals, rather than a complement to them, as most experts recommend.
Mbeki, who has resisted calls to dismiss his minister, has not spoken publicly about Rath.
However, a book by the Dr. Rath Health Foundation's spokesman in South Africa, Anthony Brink, prompted Mbeki in 1999 to question the safety of AZT, a common component of multi-drug anti-retroviral "cocktails."
His cabinet approved the national treatment plan only in August 2003, after intense international criticism and pressure from medical and civic groups. Some members of his government also had expressed concern about the disease's economic effect.
The government's past opposition to and continuing misgivings about anti-retroviral drugs conflict with most medical opinion, which says they are the best available treatment for AIDS in its advanced stages.
In March, the World Health Organization and two United Nations agencies described advertisements for Rath's vitamins as "wrong and misleading" and "an irresponsible attack on ARV therapy."
Rath, an admirer of the late Nobel Prize-winning vitamin advocate Linus Pauling, has said that multivitamins can also treat cancer, diabetes and heart disease.
In interviews, he has compared himself either to David fighting the Goliath of the global pharmaceutical industry or to scientific pioneers such as Louis Pasteur or Nicolaus Copernicus.
His website includes a gallery of people and organizations he claims are in the thrall of the "drug cartel," including President Bush, British Prime Minister Tony Blair, the World Bank and the United Nations.
"Break the chains of pharmaceutical colonialism," one advertisement last year said. Brink, the foundation's spokesman, said medical consensus had been wrong before.
"We don't allow a role for anti-retroviral drugs in the treatment of HIV/AIDS any more than we would support bloodletting," Brink said. "It's repugnant that the African poor should be burned by toxic chemicals."
In addition to the defamation lawsuit, the Treatment Action Campaign has sought unsuccessfully to bar Rath from practicing under a law that requires health practitioners to register with a local professional body. And the South African Medical Assn. has accused him of spreading "fallacious information."
Rath has faced similar problems elsewhere. The U.S. Food and Drug Administration in 2002 cautioned him about the advertising for some of his products.
Meanwhile, two years after South Africa unveiled its AIDS treatment plan, fewer than 100,000 South Africans are receiving anti-retroviral drugs, according to the Treatment Action Campaign, compared with the 600,000 to 700,000 people estimated to need them.