REAPPRAISING AIDS IN AFRICA
UNDER DEVELOPMENT & RACIAL STEREOTYPES

By Charles L. Geshekter

The problem with the truth is that it is mainly uncomfortable and often
dull .
-- H.L. Mencken

Millions of Africans have long suffered from severe weight loss, chronic
diarrhea, fever, and persistent coughs. In 1985 Western researchers
suddenly defined this cluster of symptoms as a distinct syndrome, AIDS,
and declared that it was caused by a single virus, HIV, which they
considered to be sexually contagious.(1)

American health officials universally accept this HIV-AIDS model to
explain what used to be considered the diseases of rampant poverty in
Africa. There are at least three reasons why this view needs careful
reconsideration.

First is the fact that many of the Africans who qualify for AIDS diagnoses
-- perhaps as many as 70% -- turn out to be negative when tested for HIV.

Second is the failure of the African HIV-AIDS model to predict the course
of AIDS in the United States. Since AIDS symptoms are widespread in the
general African population,(2) if it transmits heterosexually it should
also become widespread in other general populations, such as Americans, in
which hundreds of thousands of heterosexuals annually contract venereal
diseases. Instead, 16 years after it was first described in the medical
literature, in the United States AIDS has remained rigidly confined to
special risk groups. Of the 70,000 annual American AIDS patients, at least
90% are drug users (including nearly all the gay patients), and fewer than
10,000 are designated as heterosexual cases.

Third, sexual transmission can't explain the differences in rates of HIV
positivity between African (about five per 100) and American (about one
per 7,000) heterosexuals. When the HIV-AIDS paradigm made its debut in
1984, its proponents assumed that HIV was easily transmitted coitally.
Scientists tested this idea only years later, though, when they arrived at
extremely low coital transmission frequencies. The latest study shows that
an HIV-negative woman converts to positive on average only after one
thousand unprotected contacts with a positive man, and a negative man
becomes positive on average only after eight thousand contacts with a
positive woman.(3)

These data suggest two mutually exclusive conclusions. Either HIV isn't a
sexually transmitted microbe after all, and other factors account for HIV
prevalence; or African heterosexuals are wildly more promiscuous than
American heterosexuals, a scenario that surely is not true.

With all of this in mind, why do so many health professionals consider it
useful or necessary to view the diseases of poverty in Africa as sexually
contagious? And why did they ever believe it?

Defining AIDS in Africa

CDC physicians Joseph McCormick and Susan Fisher-Hoch convened the WHO
conference in the Central African Republic in 1985 that produced the
"Bangui Definition" of AIDS in Africa. The CDC had just adopted the
HIV-AIDS model to explain the diseases of American drug injectors, a
cohort of promiscuous urban gays in the party drug scene, and transfusion
recipients. HIV turned out to be one of the many viruses that tended to
react with blood from these patients. The same was true of blood from
Africans afflicted with the diseases of poverty. The HIV-AIDS model
assumed that AIDS would "spread" via HIV to a much larger fraction of
Africans than those who currently suffered from it.

McCormick and Fisher-Hoch accepted this model. They recently explained
their motivation for the conference and the rationale behind the AIDS
definition that resulted from it:
We still had an urgent need to begin to estimate the size of the AIDS
problem in Africa....But we had a peculiar problem with AIDS. Few AIDS
cases in Africa receive any medical care at all. No diagnostic tests,
suited to widespread use, yet existed...In the absence of any of these
markers [e.g., diagnostic T4/T8 white cell tests], we needed a clinical
case definition...a set of guidelines a clinician could follow in order to
decide whether a certain person had AIDS or not. [If we] could get
everyone at the WHO meeting in Bangui to agree on a single, simple
definition of what an AIDS case was in Africa, then, imperfect as the
definition might be, we could actually start to count the cases, and we
would all be counting roughly the same thing. [emphasis added]

The definition was reached by consensus, based mostly on the delegates'
experience in treating AIDS patients. It has proven a useful tool in
determining the extent of the AIDS epidemic in Africa, especially in areas
where no testing is available. Its major components were prolonged fevers
(for a month or more), weight loss of 10 percent or greater, and prolonged
diarrhea.(4)

The doctors wanted to refute the ugly moralism of the 1980s that AIDS was
a "gay plague" by convincing the American government that "AIDS was a
plague all right, but that no one was immune."(5)

McCormick and Fisher-Hoch recalled that:
experts in STDs continued to regale us with tales of the excessive and
often bizarre sexual practices associated with HIV in the West... We were
also beginning to see a direct correlation between the number of sexual
partners and the rate of infection...Compared to the West, heterosexual
contacts in Africa are frequent, and relatively free of social constraints
-- at least for the men.... There was every reason to believe that, having
found heterosexually transmitted AIDS in Kinshasa, we were likely to find
it everywhere else in the world.(6)

It was upon these grossly unscientific claims, inaccurate clinical
generalizations, western notions of sexual morality, and 19th-century
racist stereotypes about Africans that AIDS became a "disease by
definition." Africa was assigned a central role in promoting the premise
that AIDS was everywhere and everyone was at risk. By 1986, "people were
falling over one another to get involved in AIDS research," recalled the
couple. "They realized that AIDS represented an opportunity for grant
money, training, and the possibility of professional advancement... A
certain bandwagon mentality took hold. Careers and reputations were riding
on the outcome."(7)

As proof that these "AIDS symptoms" were sexually transmitted, McCormick
and Fisher-Hoch point to a narrow survey conducted by Kevin DeCock,
another CDC epidemiologist. In 1986, DeCock examined stored blood samples
taken in 1976 (for Ebola virus testing) of 600 residents of the small town
of Yambuku, in northern Zaire. Samples from five patients (0.8%) tested
positive for HIV antibodies.

DeCock wanted to know what happened to those five people during the
intervening ten years. According to McCormick and Fisher-Hoch, "three of
the five [60%] were dead. To determine if their deaths were attributable
to AIDS, Kevin interviewed people who had known them. The friends and
relatives of the deceased described an illness marked by severe weight
loss and other ailments that left little doubt in Kevin's mind that they
had succumbed to AIDS [emphases added]."(8)

DeCock concluded from these interviews that the dead subjects died from
AIDS, and that HIV had caused it. He reached this conclusion without
properly matching the five HIV-positive patients with peers from among the
595 HIV-negative subjects, and without collecting mortality data and
morbidity information about them as well. Had he done this, perhaps he
would have discovered that even HIV-negative Africans die of "severe
weight loss" and other so-called AIDS conditions.

DeCock further noted that antibody tests conducted in 1986 showed that the
HIV prevalence in Yambuku had remained constant at 0.8% during the ten
years since 1976. As far has he was concerned, this meant that HIV -- and
thus AIDS -- really did originate in Africa. HIV (AIDS) existed for years
in small numbers of rural inhabitants (who had contracted the HIV from
primates, he imagined). He speculated that once some of those people in
the late '70s migrated to what DeCock falsely assumed were sex-crazed
cities, an epidemic of HIV and AIDS exploded.

DeCock did not consider that these same data could have been interpreted
as indicating that HIV is a mild virus, and difficult to transmit. Neither
did McCormick and Fisher-Hoch.

The sort of presumptive diagnosis employed by DeCock is known as a "verbal
autopsy." It is widely accepted in Africa, where "no country has a vital
registration system that captures a sufficient number of deaths to provide
meaningful death rates."(9)

While medically certified information is available for less than 30% of
the estimated 51 million deaths that occur each year worldwide, the Global
Burden of Disease Study (GBD) found that sub-Saharan Africa had the
greatest uncertainty for the causes of mortality and morbidity since its
vital registration figures were the lowest of any region in the world -- a
microscopic 1.1% (10)

These findings prompted The Lancet to acknowledge editorially that
"current strategies to improve the world's health may need to be
reassessed" and to ponder "how much more money is spent on research into
HIV infection [the 30th cause of death] than into the causes of suicide
[#12] or the prevention of road-traffic accidents [#9] and why should this
be."(11)

Racism and African Sexuality

Whereas AIDS in the industrialized countries almost exclusively confines
itself to a tiny percentage of homosexuals, drug injectors, and
transfusion patients, AIDS afflicts the same general African population
that faces such ancient scourges as malaria, schistosomiasis, and sleeping
sickness (trypanosomiasis).

This is known as the "heterosexual paradox" of AIDS. Champions of the HIV
model attempt to explain it in two contradictory ways. Some simply declare
that the paradox is temporary. They speculate that HIV arrived first in
Africa and, in time, AIDS will be just as rampant in the West. However,
they've been saying this now for over ten years.

Others recognize the permanence of the paradox. They account for it by
declaring that Africans are just different from Westerners. They are
substantially more promiscuous and more likely to have genital ulcers. How
else to explain the widespread distribution of a virus that requires, for
non-ulcerated genitals, a thousand heterosexual acts?

At the 10th International AIDS Conference in Yokohama (August 1994), Dr.
Yuichi Shiokawa claimed that AIDS would be brought under control only if
Africans restrained their sexual cravings. Professor Nathan Clumeck of the
Universite Libre in Brussels was skeptical that Africans will ever do so.
In an interview with Le Monde , Clumeck claimed that "sex, love, and
disease do not mean the same thing to Africans as they do to West
Europeans [because] the notion of guilt doesn't exist in the same way as
it does in the Judeo Christian culture of the West."(12)

Such racist myths about the sexual excesses of Africans are old indeed.
Early European travelers returned from the continent with tales of black
men performing carnal feats with unbridled athleticism with black women
who were themselves sexually insatiable. These affronts to Victorian
sensibilities were cited, alongside tribal conflicts and other
"uncivilized" behavior, as justification for colonial social control.

AIDS researchers added new twists to an old repertoire: stories of
Zairians who rub monkeys' blood into cuts as an aphrodisiac, of ulcerated
genitals, and of philandering East African truck drivers who get AIDS from
prostitutes and then go home to infect their wives.(13)

A facetious letter in The Lancet even cited a passage from Lili Palmer's
memoirs as evidence for how a large male chimpanzee's "anatomically
unmistakable signs of its passion for [Johnny] Weismuller" on the Tarzan
set in 1946 "may provide an explanation for the inter-species jump" of HIV
infection.(14)

No one has ever shown that people in Rwanda, Uganda, Zaire, and Kenya --
the so-called "AIDS belt" -- are more active sexually than people in
Nigeria, which has reported only 3,002 cumulative AIDS cases out of a
population of 100 million, or Cameroon, which reported only 8,141 cases in
10 million. (15)

No continent-wide sex surveys have ever been carried out in Africa.
Nevertheless, conventional researchers perpetuate racist stereotypes about
insatiable sexual appetites and carnal exotica. They assume that AIDS
cases in Africa are driven by a sexual promiscuity similar to what
produced -- in combination with recreational drugs, sexual stimulants,
venereal disease, and over-use of antibiotics -- the early epidemic of
immunological dysfunction among a small sub-culture of gay men in the
West.(16)

The research from Africa suggests nothing of the sort. In 1991 researchers
from Medicins Sans Frontieres and the Harvard School of Public Health did
a survey of sexual behavior in the Moyo district of northwest Uganda.
Their findings revealed behavior that was generally not very different
from that of the West. On average, women had their first sex at age 17,
men at 19. Eighteen per cent of women and 50% of men reported premarital
sex; 1.6% of the women and 4.1% of the men had casual sex in the month
preceding the study, while 2% of women and 15% of men did so in the
preceding year. (17)

The media misrepresentations that link sexuality to AIDS have spawned
inordinate anxieties and moral panics in regions of Africa already
afflicted with extreme poverty, ravaged by war, and deprived of primary
health care delivery systems. The "disaster voyeurism" of tabloid
journalism enables them to use AIDS to sell "more newspapers than any
other disease in history. It is a sensational disease -- with its elements
of sex, blood and death it has proved irresistible to editors across the
world."(18)

Public health seems to require salesmanship, not skepticism. The media's
appetite for scary scenarios and its disdain for alternative perspectives
enables it to treat Africa in apocalyptic terms. This marketing of anxiety
helps to promote behavior modification programs to "save Africa."
Oblivious to the morbidity and mortality data from the Global Burden of
Disease Study, journalists reflexively maintain that "AIDS is by far the
most serious threat to life in Africa."(19)

The serious consequences of claiming that millions of Africans are
threatened by infectious AIDS makes it politically acceptable to use the
continent as a laboratory for vaccine trials and the distribution of toxic
drugs of disputed effectiveness like ddI and AZT. On the other hand,
campaigns that advocate monogamy or abstinence and ubiquitous media claims
that "safe sex" is the only way to avoid AIDS inadvertently scare Africans
from visiting a public health clinic for fear of receiving a "fatal" AIDS
diagnosis. Even Africans "with treatable medical conditions (such as
tuberculosis) who perceive themselves as having HIV infection fail to seek
medical attention because they think that they have an untreatable
disease."(20)

Some Western scientists, including Dr. Luc Montagnier, the French
virologist who discovered HIV, claim that the practice of female
circumcision facilitates the spread of AIDS.(21)

Yet Djibouti, Somalia, Egypt, and Sudan, where female genital mutilation
is the most widespread, are among the countries with the lowest incidence
of AIDS.

Does the "AIDS epidemic" in Africa portend the future of the developed
world? The scientific establishment certainly thinks so. Biomedical funds
that had been earmarked to fight African malaria, tuberculosis, and
leprosy are now diverted into sex counseling and condom distribution,
while social scientists have shifted their attention to behavior
modification programs and AIDS awareness surveys.

Good Intentions, Bad Science: HIV Tests and Disease

A reappraisal of AIDS in Africa must recognize that HIV tests are
notoriously unreliable among African populations where antibodies against
endemic conventional viruses and microbes cross-react to produce
ludicrously high false-positive results. For instance, a 1994 study on
central Africa reported that the microbes responsible for tuberculosis and
leprosy were so prevalent that over 70% of the HIV-positive test results
there are false.(22)

The study also showed that HIV antibody tests register positive in
HIV-free people whose immune systems are compromised for a wide variety of
reasons, including chronic parasitic infections and anemia brought on by
malaria.

The very low frequency of vaginal transmission of HIV makes it hard to
imagine that heterosexual transmission can be responsible for high rates
of HIV prevalence observed in some regions.(23)

So what is responsible?

Perhaps the tests used to determine HIV infection in Africa overstate the
prevalence. Some HIV tests detect entities believed to be part of HIV
itself, such as certain proteins or genetic sequences. But in Africa HIV
prevalence is determined by testing for antibodies, which are components
of the host immune system, not the virus. The fact that these tests react
with antibodies triggered by ordinary African microbes suggests an
explanation for HIV prevalence in Africa that is more plausible than
sexual transmission. (24)

Even the association of HIV antibody tests with ordinary infections does
not mean that positive results warrant a prognosis of death. Consider an
investigation, reported in The Lancet , of 9,389 Ugandans with unequivocal
HIV antibody test results.(25)

Two years after enrolling in the study, 3% had died, 13% had left the
area, and 84% remained. There had been 198 deaths among the seronegative
people and 89 deaths in the seropositive ones. Medical assessments made
prior to death were available for 64 of the HIV-positive adults. Of these,
five (8%) had AIDS as defined by the WHO clinical case symptoms. The
self-proclaimed "largest prospective study of its kind in sub-Saharan
Africa" had tested nearly 9400 people in Uganda, the so-called epicenter
of AIDS in Africa. Yet of the 64 deaths recorded among those who tested
positive for HIV antibodies, only five were diagnosed as AIDS-induced.

If it is not sexual transmission of HIV, then what causes the widespread
appearance of AIDS symptoms throughout Africa? The evidence strongly
implicates the ordinary, widespread socio-economic conditions that give
rise to AIDS symptoms even among HIV-negative Africans.(26)

In her meticulous 1997 doctoral dissertation, Michelle Cochrane juxtaposed
the central tenets of AIDS orthodoxy against the material record of San
Francisco AIDS patients' charts. She found that public health officials
persistently over-estimated the risk of contracting HIV/AIDS through
sexual activity, "while simultaneously under-estimating the proportion of
the HIV/AIDS caseload that were attributable to intravenous drug use
and/or socio-economic factors which condition access to health care and
prevention services."(27)

Cochrane showed that health officials conspicuously failed to investigate
all risk factors for immunological dysfunction among heterosexual adult
females.In their surveillance studies, it was considered sufficient for a
heterosexual female merely to claim that the source of her infection was
sex with an IV-drug user or another man at risk for HIV/AIDS... A
percentage of the 187 female AIDS cases [out of 24,371 cumulative cases in
San Francisco] attributed to sexual transmission could, with proper
investigation, be attributable to IV-drug use. Epidemiological research in
the United States and Europe has never proven that a female has sexually
transmitted HIV to a man. [Because] heterosexual transmission of HIV from
a male to a female happens with difficulty and very infrequently... all
AIDS surveillance statistics on female AIDS cases have been gathered
without rigorous scrutiny of the woman's risk for disease and with a bias
towards including as many women as possible [emphasis added].(28)

The a priori assumptions that directed AIDS surveillance activities in the
United States subsequently allowed predictions about an exponential spread
of the disease to survive as "common knowledge," despite the lack of
empirical data. These are critical points to consider when reviewing any
epidemiological data on "AIDS" cases in Africa.

For the period 1984-95, the WHO compared estimates of HIV seropositivity
with the actual numbers of AIDS cases in its Weekly Epidemiological
Reports. The cumulative result is that 99.95% of all Africans do not have
AIDS -- including 97% of those who test HIV-positive. These facts
strikingly contradict the popular view of an Africa overrun by fatal HIV
infections.(29)

AIDS and the Medicalization of Poverty

Primary health care systems in Africa will remain hampered until public
health planners systematically gather statistics on morbidity and
mortality to accurately show what causes sickness and death in specific
African countries. During the past ten years, as the external financing of
HIV-based AIDS programs in Africa dramatically increased, money for
studying other health problems remained static, even though deaths from
malaria, tuberculosis, neo-natal tetanus, respiratory diseases, and
diarrhea grew at alarming rates.(30)

While Western health leaders fixate on HIV, 52% of sub-Saharan Africans
lack access to safe water, 62% lack proper sanitation, and an estimated 50
million pre-school children suffer from protein-calorie malnutrition.(31)

Poor harvests, rural poverty, migratory labor systems, urban crowding,
ecological degradation, social mayhem, the collapse of state structures,
and the sadistic violence of civil wars constitute the primary threats to
African lives.(32)

When essential services for water, power, and transport break down, public
sanitation deteriorates, and the risks of cholera, tuberculosis,
dysentery, and respiratory infection increase.

WHO Director General Hiroshi Nakajima warns emphatically that "poverty is
the world's deadliest disease."(33)

Indeed, the leading causes of immunodeficiency and the best predictors for
clinical AIDS symptoms in Africa are impoverished living conditions,
economic deprivation, and protein malnutrition, not extraordinary sexual
behavior or antibodies against HIV, a virus that has proved difficult or
impossible to isolate directly, even from AIDS patients.

The so-called "AIDS epidemic" in Africa has been used to justify the
medicalization of sub-Saharan poverty. Thus, Western medical intervention
takes the form of vaccine trials, drug testing, and almost evangelistic
demands for behavior modification.

AIDS scientists and public health planners should recognize the role of
malnutrition, poor sanitation, anemia, and ordinary infections in
producing clinical AIDS symptoms in the absence of HIV.(34)

The data strongly suggest that socio-economic development, not sexual
restraint, is the key to improving the health of Africans.

Medically trained charity workers Phillipe and Evelyn Krynen, employed by
the French group Partage, in Kagera Province of Tanzania, report that when
"appropriate treatment was given to villagers who became ill with
complaints such as pneumonia and fungal infections that might have
contributed to an AIDS diagnosis, they usually recovered."(35)

A similar observation comes from Father Angelo D'Agostino, a former
surgeon who founded Nyumbani, a hospice for abandoned and orphaned
HIV-positive children in Kenya:
"People think a positive test means no hope, so the children are relegated
to the back wards of hospitals which have no resources and they die. They
are very sick when they come to us. Usually they are depressed, withdrawn,
and silent... But as a result of their care here, they put on weight,
recover from their infections, and thrive. Hygiene is excellent [and]
nutrition is very good; they get vitamin supplements, cod liver oil,
greens every day, plenty of protein. They are really flourishing."(36)

Conclusion

People can be encouraged to behave thoughtfully in their sexual lives if
they are provided with reliable information about condom use,
contraception, family planning, and venereal diseases. Multilateral
institutions and African AIDS educators should familiarize themselves with
the scientific literature that demonstrates the contradictions, anomalies,
and inconsistencies in the HIV/AIDS orthodoxy.(37)

They have a major responsibility to consider the non-contagious
explanations for "AIDS" cases in Africa and to stop the proliferation of
terrifying misinformation that equates sexuality with death. *

References
(1) Gilks CF "What use is a clinical case definition for AIDS in Africa?"
BMJ 303:1189-90, (Nov. 9, 1991).

(2) Bentwich Z, "Immune activation is a dominant factor in the
pathogenesis of African AIDS", Immunology Today 16(4):187-91 (1995).

(3) Padian N "Heterosexual transmission of HIV" Am J Epidem 146[4]:350-7
(Aug. 15, 1997).

(4) McCormick JB, Level 4: Virus Hunters of the CDC (Atlanta: Turner
Publishing, 1996) pp. 188-90.

(5) Ibid ., 176.

(6) Ibid ., 173-74.

(7) Ibid ., 179-80.

(8) Ibid ., 193.

(9) Kitange HM, BMJ 312:216-17(Jan. 27, 1997).

(10) Murray C, The Lancet 349:1269-76 (May 3, 1997).

(11) Editorial, The Lancet 349 (May 3, 1997) 1263.

(12) Jau JY Le Monde section of Manchester Guardian Weekly (Dec. 14,
1993).

(13) Conover T, "Trucking through the AIDS belt, " The New Yorker (Aug.
16, 1993).

(14) Sebastian R, "Did AIDS start in the jungle?", The Lancet 348:1392
(Nov. 16, 1996).

(15) WHO, Weekly Epidemiological Record 71(26):215 (July 1, 1996).

(16) Review of: Rotello G, Sexual Ecology: AIDS and the Destiny of Gay Men
, (New York: Dutton, 1997); Signorile M Life Outside: The Signorile Report
on Gay Men , (New York: Harper Collins, 1997); Kevles D "A Culture of
Risk", New York Times Book Review (May 25, 1997), p8; Sonnabend J, "Fact
and Speculation about the cause of AIDS," AIDS Forum 2(1):2-12; Lauritsen
J, The AIDS War (New York: Asklepios Press, 1993).

(17) Schopper D, Social Science and Medicine 37(3):401-12, (Aug. 1993).

(18) Deane J, SIDAfrique 8/9:29 (1996).

(19) Commentary, The Economist , p38 (Sep. 7, 1996).

(20) Chintu C, The Lancet 349:649 (March 1, 1997).

(21) Bass T, Reinventing the Future (Reading, Massachusetts:
Addison-Wesley, 1994).

(22) Kashala O, J Inf Diseases 169:296-304 (Feb. 1994).

(23) de Vicenza NEJM 331:341-46 (1994); and Mandelbrot L, The Lancet
349:885-89 (March 22, 1997).

(24) Papadopulos-Eleopulos E, Bio/Technology 11:696-707 (June, 1997).

(25) Mulder DW, The Lancet 343:1021-23 (April 23, 1994).

(26) Papadopulos-Eleopulos E, W J Microbiology and Biotechnology 11:141-42
(March 1995).

(27) Cochrane M, "The social construction of knowledge on HIV and AIDS,"
PhD dissertation, Department of Geography, UC-Berkeley (April 1997), p.
7.

(28) Ibid . , pp. 259-60.

(29) WHO, World Health Report 1996 , p130.

(30) WHO, Bridging the Gaps (Geneva: WHO, 1995), Table 5 and Table A3;
WHO, World Health Report 1996, Table 4 and Table A3.

(31) The Lancet , p69 (Jan. 11, 1997).

(32) Murray C, The Global Burden of Disease (Cambridge: Harvard Univ.
Press, 1996).

(33) WHO, The World Health Report 1995 .

(34) Geshekter C, Transition 67:4-14 (Fall 1995); Patton C, Inventing AIDS
(New York: Routledge 1990).

(35) Hodgkinson N in Duesberg P, AIDS: Virus or Drug Induced? (Dordrecht:
Kluwer, 1996), p. 353.

(36) Ibid ., pp. 350-51.

(37) Chirimuuta R, AIDS, Africa, and Racism (London: Free Association
Press 1989); Root-Bernstein R, Rethinking AIDS (New York: Free Press
1993); Duesberg P, Infectious AIDS: Have We Been Misled? (Berkeley: North
Atlantic Books 1996); Brody S, Sex at Risk; Lifetime Number of Partners,
Frequency of Intercourse and the Low AIDS Risk of Vaginal Intercourse ,
(New Brunswick: Transaction Pubs., 1997)