Got AIDS? Take two cloves of garlic and call me in the morning

South Africa's Ministry of Health announced on February 13th that it promotes 'free will' in regard to the use of traditional medicines by those living with HIV/AIDS. The Ministry, in other words, is officially neutral: when a South African's immune system becomes compromised by HIV, they can use drug treatment, or they can go to their local sangoma and get the latest concoction. The Ministry of Health does not want to state a preference for anti-retroviral drugs above herbs, micronutrients, garlic or whatever.

Lurking behind this position of neutrality is a longstanding battle between the South African government, health care professionals, biomedical researchers and AIDS activists. The current South African president Thabo Mbeki used to publicly state that HIV does not cause AIDS, relatively few people in South Africa die of AIDS, and that anti-retroviral drugs are unsafe and part of a neo-colonial plot on the part of Western pharmaceutical companies. He no longer needs to, because now he has a Health Minister (Manto Tshabalala-Msimanga) who says anti-retroviral drugs are merely an 'option' for AIDS patients, and a healthy diet can be just as effective in controlling the virus. Mbeki has a theory, but Tshabalala-Msimanga translates it into health policy, under the fashionable guises of 'patient choice' and 'respect for indigenous culture.'

This policy of 'neutrality' needs to be evidence-based. The South African Ministry of Health should sponsor an independently monitored clinical trial comparing herbs, micronutrients, garlic, lemon rind (and whatever) against first-line antiretroviral drugs on persons with CD4 count of <200. Nearly everyone in the scientific community would predict a whole lot more death in the 'garlic' arm of the trial, but since the Ministry of Health claims they are equally effective, they at least have clinical equipoise. So they can do it. But they won't.