Your Medicine Men find the AIDS-in-Africa story very difficult to sort out. This should not be surprising, since no one else has
sorted it out, either.
Social and political factors complicate the situation; reliable information is rare.
But it is possible to suggest not only that the AIDS "epidemic" is vastly overstated and overrated, but also that resources spent
fighting it might better be employed on more basic, and more general, infrastructure and health needs. This is not to deny the
reality or the tragedy of this disease or the many other diseases rampant in poor parts of Africa. It is to point out that, when
medical realities collide with scaremongering and false realities, the latter too often triumph.
Even today, the cause for Acquired Immune Deficiency Syndrome (AIDS or HIV/AIDS) remains controversial.
Most HIV/AIDS diagnoses are not based on identifying the HIV virus itself but by finding an antibody to the virus in the
bloodstream. The virus does not seem to directly damage many cells but is thought to impede immune system function.
Some scientists find that other physiological insults, such as overwhelming and repeated infections from contaminated IV
needles used by drug abusers and from homosexual sexual activity, overwhelm and weaken the immune system, and cause
most AIDS cases.
On top of these controversies, the criteria for diagnosing AIDS have changed three or four times. And each time the criteria
change, the number of people qualifying for the diagnosis increases.
In the past, a person might have HIV antibodies and tuberculosis; nowadays, this counts as HIV/AIDS, as do dozens of other
combinations of signs and symptoms. These changing criteria result in higher numbers of people being diagnosed with AIDS
with each change in the criteria, creating an epidemic of diagnostic "grade inflation."
In this country, homosexual sex and the use of contaminated hypodermic needles are the most common routes for spread of
the HIV virus, with the mix of transmission paths also remaining controversial. In the developed world, health statistics derive
from professional practice and sophisticated sampling techniques.
In Africa, poverty, distance and isolation make accurate, continent-wide diagnosis and statistics impossible. As a result, most
health and population statistics are estimates or guesses, often driven by political and cultural agendas and always driven by the
need to generate more outside funding from wealthier regions of the world. Thus, the severity of just about everything gets
This is especially true for AIDS. Proper diagnosis can require trained medical people, medical history, physical examination,
blood tests and sophisticated facilities. These are rare in most parts of Africa, and few Africans can afford this level of medical
care even where it is available.
AIDS information is also difficult to assess because the definition of AIDS is different in Africa. Indeed, blood test results don't
even figure in the official diagnostic criteria.
It's all done on "points" defined at the "AIDS in Africa" meeting in Bangui in October 1985. This meeting resulted in a U.N.
document (Bangui1985report.pdf) that described Africa as a continent "where adequate laboratory facilities are often lacking."
Because of this lack, the meeting participants concluded that AIDS in Africa could be diagnosed without a blood test by
scoring 12 points out of a possible total of 50, based on symptoms and signs alone.
People having the first three (10 percent weight lost, protracted asthenia [weakness] and repeated attacks of fever for more
than a month) have already racked up a score of 11. A cough scores two more points, and "the diagnosis of AIDS is
Many other non-specific signs are worth points, such as diarrhea, lung disease, signs consistent with herpes virus infections,
generalized lymph node enlargement and "neurological signs." In other words, many Africans diagnosed with AIDS would not
carry the diagnosis in the developed world. And many people have these qualifying symptoms from the many other diseases
prevalent in poor regions.
Scientists have done some studies including blood tests. These have limited value because many of the needles used are
already contaminated. In the U.S., almost all injection needles are discarded after a single use. In parts of Africa, needles are
often re-used in medical clinics without thorough cleaning (much less sterilization) between uses.
Also, because of popular distrust of government clinics, many needles are used at home, where they're even less likely to be
sterilized between uses. Indeed, according to the article "Mounting Anomalies in the Epidemiology of HIV in Africa: Cry the
Beloved Paradigm," in the March 2003 International Journal of STD and AIDS, contact with contaminated blood via needles
and transfusions, and not sex, may well be the primary infection route for two-thirds of the HIV infections.
But if it is impossible to determine the extent of the epidemic, it should be easy to tell whether AIDS has, as predicted,
"decimated" sub-Saharan Africa. Clearly, this has not happened. Sub-Saharan Africa's population is estimated to have
increased by 73 percent over the last two decades, to 752 million (according to the Population Reference Bureau's 2005
World Population Data Sheet at http://www.prb.org/pdf05/05WorldDataSheet_Eng.pdf) from 434 million in 1985 (according
to the U.N. Population Division, as reported by Tom Bethell in "The American Spectator," October 2005).
In another analysis, South Africa's population continues to grow at a rate most consistent with "no AIDS" projections. In other
words, predictions based on the hypothesis that AIDS kills have not come true.
But even if these population estimates are way off, one implication is clear. Committing resources to fight a non-existent
epidemic makes no sense, except to those making a living off the funds generated by the scares. Resources fighting phantom
epidemics can't be used to improve basic sanitation and nutrition, the foundations of health.
In sum, it is quite possible that fighting AIDS as the scaremongers desire would kill and sicken more people than AIDS
treatment would save.
Editor's Note: Robert J. Cihak submitted this week's comment.