poverty, not AIDS, killing Africans

[michael at ecst.csuchico.edu]

The author is a former friend, now a very meanspirited conservative
activist.
> 
> [via Sid Shniad]
> 
> Globe and Mail (Toronto) - March 14, 2000
> 
> THE PLAGUE THAT ISN'T
> 
> Poverty is killing Africans, not an alleged AIDS pandemic,
> says U.S. policy adviser Charles Geshekter
> 
> By Charles Geshekter
> 
> The United Nations calls it the "worst infectious disease catastrophe 
> since bubonic plague." U.S. Senator Barbara Boxer advocates spending 
> $3-billion to "fight AIDS." And delegates at last month's National 
> Summit on Africa in Washington pleaded for more money to wage war on 
> AIDS. But the scientific data do not support these claims. The whole 
> subject needs a healthy dose of skepticism.
> 
> I recently made my 15th trip to Africa to find out more. Let's start 
> with a few basic facts about HIV, AIDS, African record-keeping and 
> socio-economic realities. What are we counting? The World Health 
> Organization defines an AIDS case in Africa as a combination of 
> fever, persistent cough, diarrhea and a 10-per-cent loss of body 
> weight in two months. No HIV test is needed. It is impossible to 
> distinguish these common symptoms -- all of which I've had while 
> working in Somalia -- from those of malaria, tuberculosis or the 
> indigenous diseases of impoverished lands.
> 
> By contrast, in North America and Europe, AIDS is defined as 30-odd 
> diseases in the presence of HIV (as shown by a positive HIV test). 
> The lack of any requirement for such a test in Africa means that, in 
> practice, many traditional African diseases can be and are 
> reclassified as AIDS. Since 1994, tuberculosis itself has been 
> considered an AIDS-indicator disease in Africa.
> 
> Dressed up as HIV/AIDS, a variety of old sicknesses have been 
> reclassified. Post mortems are seldom performed in Africa to 
> determine the actual cause of death. According to the Global Burden 
> of Disease Study, Africa maintains the lowest levels of reliable 
> vital statistics for any continent -- a microscopic 1.1 per cent. 
> "Verbal autopsies" are widely used because death certificates are 
> rarely issued. When AIDS experts are asked to prove actual cases of 
> AIDS, terrifying numbers dissolve into vague estimates of HIV 
> infection.
> 
> The most reliable statistics on AIDS in Africa are found in the WHO's 
> Weekly Epidemiological Record. The total cumulative number of AIDS 
> cases reported in Africa since 1982, when AIDS record- keeping began, 
> is 794,444 -- a number starkly at odds with the latest scare figures, 
> which claim 2.3 million AIDS deaths throughout Africa for 1999 alone.
> 
> More reliable, locally based statistics rarely exist. In December, I 
> interviewed Alan Whiteside of the University of Natal, a top AIDS 
> researcher in South Africa and asked for details of the alleged 
> 100,000 AIDS deaths in South Africa in the last year. He laughed 
> aloud. "We don't keep any of those statistics in this country," he 
> said. "They don't exist."
> 
> And South Africa is more advanced than most African countries in that 
> it conducts HIV tests in surveys of about 18,000 pregnant Africans 
> annually. The HIV-positive numbers are then extrapolated. But there 
> are two problems with this: The women are given a blood test known as 
> ELISA, which frequently gives a "false positive" result (one 
> condition that can trigger a false alarm is pregnancy). Even the 
> packet insert in the ELISA test kit from Abbott Labs contains the 
> disclaimer: "There is no recognized standard for establishing the 
> presence or absence of HIV-1 antibody in human blood."
> 
> Secondly, it's well understood that many endemic infections will 
> produce so much cross-contamination that a single ELISA test is 
> virtually useless. When I asked Thuli Nxege, a 28-year-old domestic 
> worker from a rural Zulu township, what made her neighbours sick, she 
> cited tuberculosis, and added that the lack of sanitary facilities 
> and having open latrine pits adjacent to village homes made it 
> difficult to prepare clean food.
> 
> Beauty Nongila, principal of a rural school in north Zululand, 
> insisted that having more toilets would improve the health of her 408 
> students (her sparsely-equipped elementary school has four). She 
> struggled to provide her underfed kids with a spartan lunch on an 
> allowance of 8 cents a day. When I inquired about the AIDS crisis, 
> she laughed and said that dental problems, respiratory illnesses, 
> diarrhea and chronic hunger were far more vexing.
> 
> Figures about children orphaned by AIDS also bear closer examination. 
> The average fertility rate among African women is 5.8 and the risk of 
> death in childbirth is one in three. The African life span is not 
> long -- 50 for women and 47 for men -- so it would not be surprising, 
> on a continent of 650 million people, if there were not even more 
> than 10 million children whose mothers had died before they reached 
> high- school age.
> 
> The scandal is that long-standing ailments that are largely the 
> product of poverty are being blamed on a sexually transmitted virus. 
> With missionary-like zeal, but without evidence, condom manufacturers 
> and AIDS fund-raisers attribute those symptoms to an "African sexual 
> culture." Rev. Eugene Rivers of Boston has launched a crusade to 
> change African sexual practices -- a crusade reminiscent of Victorian 
> voyeurs whose racist constructs equated black people with sexual 
> promiscuity.
> 
> In South Africa, which will host the International AIDS Conference in 
> July, criticism is on the rise. Some journalists and physicians are 
> challenging the marketing of anxieties and questioning the epidemic.
> 
> Late last year, South African President Thabo Mbeki launched an 
> investigation into the safety and benefits of AZT, a toxic and 
> expensive drug that produces abnormalities in laboratory animals; its 
> life- extending benefits remain unproved. South Africa's Minister of 
> Health, Manto Tshabalala-Msimang (a physician herself), told South 
> African television audiences in December that she would not recommend 
> AZT, advice echoed on the same program by Dr. Sam Mhlongo of the 
> National Medical University in Pretoria.
> 
> I'd argue that wearing red ribbons or issuing calls to condomize the 
> continent will do little for the health of Africans. By contrast, a 
> 1998 study of pregnant, HIV-positive women in Tanzania showed that 
> simply providing them with inexpensive micronutrient supplements 
> produced beneficial effects during and after pregnancy. The 
> researchers found that women who received prenatal multivitamins had 
> heavier placentas, gave birth to healthier babies and showed a 
> noticeable "improvement in fetal nutritional status, enhancement of 
> fetal immunity and decreased risk of infections."
> 
> Once AIDS activists consider the non-contagious, indigenous-disease 
> explanations for what are called AIDS, they may see things 
> differently. The problem is that dysentery and malaria do not yield 
> headlines or fatten public-health budgets. "Plagues" and infectious 
> diseases do.
> 
> This means that those who question AIDS in Africa put their own 
> funding at risk. I saw this at first-hand when I visited Swaziland in 
> mid- December at the invitation of their HIV/AIDS Crisis Management 
> Committee. I was driven from the airport to the hotel in a late model 
> 4-wheel drive vehicle. It had been donated by UNICEF and was covered 
> with AIDS posters urging Swazis to "use a condom, save a life." The 
> committee included representatives of the major government 
> ministries, as well as church and women's groups.
> 
> After my presentation, an attorney named Teresa Mlangeni acknowledged 
> that she could easily see how malnutrition, tuberculosis, malaria and 
> other parasitic infections -- not sexual behaviour -- were making her 
> fellow Swazis ill. But other committee members confided that if they 
> voiced public doubts, they risked losing their international funding. 
> And I realized that the vested interests of the international AIDS 
> orthodoxy would discourage further inquiries.
> 
> Traditional public-health approaches, clean water and improved 
> sanitation above all can tackle the underlying health problems in 
> Africa. They may not be sexy, but they will save lives. And they will 
> surely stop terrorizing an entire continent.
> 
> Charles L. Geshekter is a three-time Fulbright scholar who teaches 
> African history at California State University in Chico. He has 
> served as an adviser to the U.S. State Department and several African 
> governments.
> 

-- 
Michael Perelman
Economics Department
California State University
Chico, CA 95929

Tel. 530-898-5321
E-Mail michael at ecst.csuchico.edu