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A new urgency
With his country at the epicenter of an AIDS epidemic, the special advisor to South Africa's health minister quietly makes his first trip to an important research conference.

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By Emily Bass

Feb. 4, 2000 | SAN FRANCISCO -- South Africa is at the epicenter of the sub-Saharan AIDS epidemic. At least 3 million South Africans, or 13 percent of the population, is infected with HIV. In urban areas like Durban and Johannesburg, up to 35 percent of pregnant women carry the virus.

The country is also at the center of a political maelstrom around access to life-saving antiretroviral medications. An ongoing lawsuit brought by more than 40 pharmaceutical firms has South Africa's "Medicines Act" (which would allow the country to produce cheaper versions of life-saving medications) tied up in court. At a special meeting in January, the United Nations Security Council warned of the political instability that could result from sub-Saharan Africa's skyrocketing death rates.

Yet it was with little fanfare -- and without official registration -- that Dr. Ian Roberts, four years into his job as special advisor to South African Minister of Health Manto Tshabalala-Msimang, made his first appearance at the Conference on Retroviruses and Opportunistic Infections in San Francisco this week. The conference -- this year's is the seventh -- is considered a can't-miss stop on the circuit of AIDS research events, drawing 3,200 researchers from around the world to present on a dizzying array of topics. It's a kaleidoscope of statistics, conjecture and, occasionally, stunning new developments in the field of HIV. For Roberts, it was also the place to start a crash course, of sorts, in state-of-the-art research on HIV.

A slight, haggard-looking man with a penchant for elaborately patterned sweaters, Roberts used the conference for a decidedly informal fact-finding tour, capitalizing on on-site introductions to Tony Fauci, head of the National Institute of Allergy and Infectious Diseases, as well as other experts, and sitting down to dinner with everyone from ACT UP-New York to Peter Salk. A physician and co-developer of the "abortion pill" (RU-486), Roberts was no stranger to medicine -- or controversy -- when he accepted his appointment four years ago. Although he doesn't have the power to execute policy changes, Roberts has drawn criticism from South African activists and industry alike.

His unprecedented visit to the retroviruses conference raised hopes and questions about possible new directions in South Africa's official approach to the epidemic. "I'm an existentialist," he said. "Which means, I suppose, that you don't have responsibility unless you take it -- and then when you take it, you have it." His elliptical, if not evasive, responses to proposals of specific treatment plans frustrated some activists and researchers at the conference. Salon sat down with him to find out what, exactly, he sees as his mandate.

You missed the registration deadline for this conference. Why did you decide it was still important to attend?

It's an opportunity to network, which I don't think we've done particularly well before. For example, if I talk with enough people that know enough about vaccines, we might save ourselves an enormous amount of work as we start to develop a vaccine against HIV subtype C [the most common strain in sub-Saharan Africa]. I also wanted to see what was relevant to Africa and Asia at a major conference. I'm interested in what groups of high-level research scientists are doing about HIV. What messages are there for us?

What did you find?

A small number of presentations that mention Africa, but very little that illustrates a group like this is really focused on the epicenter of the epidemic.

Vaccines are a huge priority right now. Where do you see progress coming from in this area?

It has to be global effort. All relevant people need to come together one way or another and lose protectionism and desire to leverage themselves and just focus on what we need. It's not a question of do we have the budget. It's that if we don't solve it, the ramifications are going to be enormous. In a sense, it's a shame we don't have complete, total global dictatorship for a year where one individual says, "Either you do it or you die."

Do you see this global involvement happening?

On the flight here, I flew next to someone from Shell -- it could have been anybody, from any company. I always ask people the same question, partly because it gives them a level of discomfort: "What are you doing about AIDS? What is your company doing about AIDS?" He said, "Well it's not Shell's problem." If I had a company, or was managing director of Shell now, I would be very focused on what I could do. Not only because my marketplace is going to change tremendously, but also because there's a responsibility when a continent is facing what we are. Three or four months ago, I didn't have the same sense of urgency I have now, so I can understand if Shell doesn't have that urgency. Still, it seems surprising to me that it's not there.

So, something's changed for you recently. Where has your sense of urgency come from?

It's hard to say exactly. One thing may be that there are very few people that I'm close to, or that I like, and one of them died recently of non-Hodgkin's lymphoma [an AIDS-related illness]. He was a fashion designer and worked for Missoni with my wife.

What's the most important insight you've gotten here?

I think for me -- and this is most probably obvious to people who've been in this area for some time -- is to begin to explore use of micronutrients, deparatization [treating for worms and other parasites than can make the immune system more vulnerable to HIV], vitamin A supplements. Those are things we have to do anyway in South Africa. Other ideas that are important are use of ddI and hydroxyurea [two low-cost anti-HIV drugs] in an African context. Some immunotherapies might work in a South African context, as well. All are fairly new to me as concepts.

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