Health Minister Dr Manto Tshabalala-Msimang has for the past three years been promoting an untested diet for people with AIDS-related illnesses, and now believes that it could be an alternative to antiretroviral (ARV) drugs.

As the AIDS epidemic intensifies, thousands of sick and desperate people have turned to controversial nutrition nurse Tine van der Maas who advocates that the immune system can be restored through a diet based on garlic, lemons, olive oil and a supplement called Africa’€™s Solution.

Tshabalala-Msimang has allowed Van der Maas access to public hospitals and clinics countrywide to give her as-yet-untested diet to desperately sick hospital patients.

The Minister recently told a press briefing that people living with HIV had ‘€œthree choices’€: nutrition, micronutrients or antiretroviral drugs.

‘€œMaybe someone can stand up and function if they have antiretrovirals. With nutrition they are functional and there is no information that it has side effects … Micronutrients boost the immune system,’€ she said.

While there is widespread consensus that good nutrition is an essential part of any HIV/AIDS treatment plan, medical experts believe it should be offered to complement ARV treatment.

The Treatment Action Campaign’€™s (TAC) Nathan Geffen accused Van der Maas of giving people ‘€œfalse hope’€ and said ‘€œit is absolutely unethical to promote nutrition as an alternative to antiretrovirals, as ARVs are the only thing scientifically proven to reverse the course of AIDS’€.

Van der Maas says that she was able to conduct ‘€œtrials’€ with patients at St Barnabas Hospital in the Eastern Cape, Temba Hospital in Mpumalanga, Makopane Hospital in Limpopo, Bloemfontein Provincial Hospital in the Free State and Kimberley Provincial Hospital in the Northern Cape.

Confirming the list of hospitals, Health Director-General Thami Mseleku, Van der Maas had been ‘€œinvited by MECs of Health to do voluntary work with AIDS patients’€ at these hospitals and ‘€œvarious clinics in all provinces’€.

This was after Tshabalala-Msimang arranged for Van der Maas to address a meeting of all provincial health MECs.

However, the Department appears not to have documented the effects of the diet on its patients as Mseleku said such documentation was only available from Van der Maas.

In addition, he said the findings from a clinical trial on the effects of Africa’€™s Solution on 50 patients would only be presented at next month’€™s national AIDS conference by Dr Elmien van der Heever from Bloemfontein Technikon/University.

Tshabalala-Msimang has also referred a number of private patients to Van der Maas, mostly from ‘€œtop families in the ANC and government’€.

Van der Maas and Winston Wilken, who sells the Africa’€™s Solution supplement, have also been working with top military officials, retail stores and corporations.

As further proof of the Minister’€™s support, Dr Cyril Khanyile, a medical advisor in the Health Department’€™s HIV/AIDS Directorate, is assisting and advising Van der Maas.

Professor Nigel Rollins, chairperson of the World Health Organisation’€™s (WHO) technical advisory group on nutrition and HIV/AIDS, said he would be ‘€œdelighted’€ if the diet worked, but that ‘€œany product should be doubted until it is properly tested’€.

‘€œIt is irresponsible to go out and make vast claims if your product has not been tested. In science, there is an agreed on way of testing products and diets. One thing the government could do would be to fund a study on Van der Maas’€™s diet that is conducted by an objective set of scientists,’€ said Rollins.

Professor Ronald Green Thompson, head of health in KwaZulu-Natal, confirmed that his department was looking into testing the diet.

‘€œThe anecdotal evidence about Van der Maas’s project is sufficiently strong for the department to explore it further and also undertake scientific evaluation,’€ said Green Thompson. ‘€œThe department will identify role players who will be able to add value to the project.’€

Harvard infectious diseases expert Dr Krista Dong, who established iThemba HIV/AIDS clinic at St Mary’€™s Hospital outside Durban, said that while good nutrition could slow the progression of HIV, it could not replace ARVs.

‘€œAt iThemba, before starting patients on ARVs, we would try to stabilise them by treating the underlying opportunistic infections such as TB and ensure they had sufficient food. There was a dramatic improvement in energy, weight gain and general well being within a few days just from doing so.

‘€œHowever, these gains cannot be sustained once HIV has progressed towards AIDS.   At that point, ARVs are critical to bring down the patient’€™s viral load and increase the chance for a successful and sustainable response to the TB and other medications.’€    

For four months between last October and February, Van der Maas was based in KwaNgcolosi outside Durban at a project run by a Belgian, Kim Cools.

Van der Maas, who was only paid for expenses by the health department, says she spent her ‘€œlast money’€ filming the effect of the diet on almost 400 people at KwaNgcolosi.

In the video, parts of which were screened recently on SABC’€™s Channel Africa, Van der Maas claims that the diet had a marked impact on a range of afflictions including ‘€œcataracts, epilepsy, diabetes and acquired immune deficiency symptoms’€.

However, TAC’€™s Geffen says that the video ‘€œundermines the whole of medical science by making unsubstantiated claims about the effects of the diet on a wide range of illnesses’€.

Tshabalala-Msimang visited Van der Maas twice while she was at KwaNgcolosi, on one occasion bringing with her health officials including Mseleku and Green-Thompson.

Van der Maas’€™s diet is based on the use of garlic and ginger to treat infections and olive oil, lemon juice and peel to detoxify the body. She then advocates ProNutro which contains selenium and a supplement called Africa’€™s Solution, which contains African potato extract and vitamins.

The positive effects of a Mediterranean diet high in garlic and olive oil have been established by numerous scientific studies over many years.

In addition, a number of studies presented at the recent WHO consultation on AIDS and nutrition showed that certain vitamins, minerals and trace elements helped to slow the progression of HIV.

Nozipho Bhengu, daughter of ANC MP Ruth Bhengu, has been following Van der Maas’€™s diet for the past two years. When she started, she was hospitalised with a CD4 count (measure of immunity) of  55 and adverse reactions to ARVs. She stopped the ARVs, followed the diet and her CD4 count increased to 135 over three months.

‘€œI have been concentrating on the lemon juice, olive oil, garlic, ginger and African Solution and it has worked. Now I am working. I am normal just like anybody else,’€ says Bhengu.

Criselda Kanana, who was diagnosed with HIV in 1997 and has an AIDS talk show on Khaya FM, says she has been following Van der Maas’€™s diet for a number of years and has never had a CD4 count below 600.

Kanana believes more people diagnosed with HIV need a ‘€œproper wellness programme instead of being told the are going to die’€.

But any possible benefits of Van der Maas’€™s programme are being overshadowed by the fact that it is being used by AIDS dissidents (who don’€™t believe HIV causes AIDS) to gain access to communities in order to discredit ARVs.

Having failed in their campaign to stop government from introducing ARVs in the public sector, key AIDS dissidents have regrouped around Van der Maas’€™s programme and are using it as an entry-point to persuade communities to reject ‘€œtoxic’€ ARV drugs.

Despite having worked with AIDS patients for 20 years, last year Van der Maas expressed doubts about the existence of HIV.

She has established links with former magistrate Anthony Brink, the country’€™s most outspoken AIDS dissident, and the Rath Foundation, which assisted with production costs of her video.

Dr Matthias Rath, who sells vitamins and has been running an advertising campaign against ARVs, is currently involved in a court case with the TAC, which has accused him of libel.

Brink, who now works for the Rath Foundation, was instrumental in getting Van der Maas to KwaNgcolosi by introducing her to Kim Cools, the Belgian AIDS dissident who was running a environmental  programme in the area.

Cools believes that there is no role for medicine as ‘€œa healthy body should be able to cure itself’€.

However, Van der Maas insists that she never tells people to stop their medication without checking with their doctor.

Khanyile, who says he has worked with AIDS patients in the US for 20 years, says he is against a ‘€œone size fits all’€ approach to health.

‘€œIf a patient on ARVs comes to me and they don’€™t have any problems, I tell them to stay on the ARVs,’€ said Khanyile.

While Khanyile was not prepared to ‘€œcommit one way or the other’€ on whether HIV was ‘€œsimply a particle or a true virus’€, he said he believed that there were a range of other players in immune deficiency including ‘€œthe herpes virus, genetics, environmental issues such as poverty and nutritional deficiencies’€.

When asked whether they would be prepared to take part in a scientific study on the diet, Khanyile said: ‘€œWe don’€™t want to be tied up with scientists in a laboratory. But we would be prepared for the diet to be given to patients in an academic hospital where the benefits can be monitored by an independent, neutral person.’€

Dr Ali Dhansay, director of the Medical Research Council’s Nutritional Intervention Research Unit, welcomed the fact that the proponents of the diet were amenable to having it tested.

“There are a range of methods of testing that don’t necessarily involve only a laboratory. What would need to happen is for the role players to sit down and develop a protocol identifying what the research questions are, and the appropriate study design to answer these questions,” said Dhansay.

E-mail Kerry Cullinan