A CRITICAL REAPPRAISAL OF AFRICAN AIDS RESEARCH AND WESTERN SEXUAL STEREOTYPES By Charles Geshekter May 1999 http://www.virusmyth.net/ "The problem with the truth is that it is mainly uncomfortable and often dull" -- H.L. Mencken Introduction In his installation address at the University of Witwatersand in March 1998, Vice Chancellor Colin Bundy reminded the audience that a university "must encourage its academics and students never to take knowledge as given, as fixed: they must recognize that knowledge is 'socially sustained and invested with interests and backed by power'."(1) This advice will be worth remembering when researchers gather in Durban (July 2000) for the 13th International AIDS Conference, trying to resolve the paradoxes and contradictions that arouse serious concern about the reliability of African AIDS research. In the United States, where AIDS was first identified, a remarkable imprecision about the definition of this syndrome and its causation has clouded the public's understanding of HIV and AIDS, abetted by a lack of journalistic and social science scrutiny. This paper evaluates how the unverifiable assumptions and inaccurate predictions that turned "AIDS is everywhere" into a quasi-religious American cliché are perpetuated in Africa. The paper scrutinizes the predictions of increased numbers of HIV cases in southern Africa by reviewing comparative studies from other parts of Africa to show how conceptual flaws and dubious statistics mar conventional studies about AIDS in Africa. It suggests that western stereotypes, poorly designed research, medical authoritarianism and racist assumptions about African sexuality created the untenable conclusions about AIDS in other African countries that now proliferate in South Africa, Zimbabwe and Botswana. In a critique of "armchair empiricism" that would apply to much AIDS research, Margo Russell and Mary Mugyenyi show how analysts often squeeze "African data into inappropriate Western categories" and "international agencies, with their passion for international comparison...exert a strong pressure for just the kind of standardization that sociologists should be well-placed to reject."(2) Because Africa plays a major role in the alarming predictions about increased AIDS incidence, it is crucial to distinguish between a virus (HIV) and a syndrome (AIDS) in order to recognize how ambiguous definitions have helped to spawn misinformation about AIDS. Part of this problem arises from the alphabetic shorthands that are often used interchangeably: HIV, HIV disease, HIV infection, HIV/AIDS, AIDS, STD/AIDS, TB/AIDS, STD/TB/AIDS. In July 1997, a regional health department in South Africa concluded that it was "outdated and inaccurate" to say that someone "has AIDS." Rather than distinguish between an HIV antibody test and an actual AIDS case, the Gauteng Health Department decided it would henceforth use the term "HIV infection" to include every stage of infection and disease.(3) This critical shift in terminology usually is ignored in media accounts that predict African life expectancy or death rates based on projections of HIV infections. Discrepancies are also evident when comparing HIV and AIDS figures in the annual World Health Reports (issued by the World Health Organization) and its Weekly Epidemiological Record (WER) with those used in a highly publicized and frequently cited Report on the Global HIV/AIDS Epidemic that was widely distributed at the International AIDS Conference in Geneva (June 1998).(4) In November 1998, the WER provided the totals of AIDS cases for a 15-year period (1982-1997) in the following countries: Nigeria (21,905); South Africa (12,825); Uganda (53,306); and Tanzania (97,621).(5) The World Health Report 1998 which claims to "use the latest data gathered and validated by WHO" gives the following numbers of AIDS cases in those four countries for 1996: Nigeria - 308; South Africa - 729; Uganda -3,021; and Tanzania - 0.(6) When the Report on Global the HIV/AIDS Epidemic conflated the number of actual AIDS cases with the estimated number of Africans said to be HIV-positive, these were the results:   Estimated number living with HIV/AIDS Nigeria 2.3 million South Africa 2.9 million Uganda 1.9 million Tanzania 1 million By analyzing the epidemiological data from studies that claim to show the sexual transmission of a virus thought to cause immune deficiency in Africa, this paper argues that conventional ideas about the viral causes of AIDS are not subjected to the same standards of verification used in the empirical sciences. For instance, a survey of adult mortality in Lusaka, Zambia cited the most frequently reported causes of death to be "diarrhoea (20%), malaria or fever (9%), witchcraft (7%), tuberculosis (7%), and cough (6%). AIDS was given as the cause in 3% of deaths." The researchers breezily concluded that since "HIV seroprevalence in Lusaka is currently 25-30%, and given the unusual prominence of diarrhoeal disease as a cause of death, we believe that HIV infection is largely responsible for the high death rate [emphasis added]".(7) Before international donors pour more money into African AIDS research, or conduct another knowledge-attitude-practice survey, or advocate modifying anyone's sexual behavior, they must subject their most basic suppositions about AIDS cases in Africa to the standards of consistency, testability and parsimony required in empirical science. Unless researchers concur on which surveillance methodology is used to carefully define a case of "AIDS," they will disagree on substantive policy recommendations regarding AIDS prevention. It is important for African social scientists to gather data, weigh and interpret evidence and verify the accuracy of claims made by international AIDS experts. Some prominent South Africans have begun to demand far more reliable data to show how HIV infection actually spreads via migrant laborers or truck drivers. The editor of the South African Medical Journal, Daniel Ncayiyana, questioned the uncritical way that HIV and AIDS statistics are selectively gathered from women at antenatal clinics, then projected as representative of the entire country. He pointed out that a "gaping discrepancy in prevalence between KwaZulu-Natal and the eastern Cape remains unelucidated" and wondered why the "actual trail of infection from the city to rural areas has not been properly traced."(8) Answers to these and other questions may be found through a critical re-appraisal of HIV/AIDS research elsewhere in Africa. 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 alleged could be easily transmitted through sexual contact.(9) 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 Africans who qualify for an AIDS diagnosis - perhaps as many as 70% - turn out to be negative when tested for HIV according to the Western Blot. Second is the failure of this African HIV/AIDS model to predict the course of AIDS in the United States. Since AIDS symptoms are widespread in the general African population, 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, 17 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 identified as heterosexual cases. Third, sexual transmission cannot explain the differences in rates of HIV positivity between African (about five per 100) and American (about one per 7000) heterosexuals. When the HIV/AIDS paradigm made its debut in 1984, its proponents assumed that HIV was easily transmitted coitally. Scientists only tested this idea ten years later, when they arrived at extremely low coital transmission frequencies. Researchers routinely classify "HIV infection" as a sexually transmitted disease (STD) without acknowledging the extraordinary difficulty of alleged sexual transmission of HIV. The latest studies by Nancy Padian and her associates demonstrate that the infectivity rate for male-to-female transmission is extremely low, "approximately 0.0009 per contact," while female-to-male transmission is eight times less efficient.(10) In other words, an HIV-negative woman may convert to positive on average only after one thousand unprotected contacts with an HIV-positive man. An HIV-negative man may become positive on average only after eight thousand contacts with an HIV-positive woman. These data suggest two mutually exclusive conclusions. Either HIV is not a sexually transmitted microbe after all and other factors must account for HIV seroprevalence or African heterosexuals are wildly more promiscuous than American heterosexuals, a scenario that is surely not true but does perpetuate centuries-old western stereotypes. With all of this in mind, why do so many health professionals and public health officials consider it useful or necessary to view the diseases of poverty in Africa as sexually contagious? And why did they ever believe it? How can one virus cause 29 heterogeneous "AIDS indicator" diseases almost entirely among males in Europe and America but afflict African men and women in nearly equal numbers?(11) The answer is that the World Health Organization uses a definition of AIDS in Africa that differs decisively from the one used in the West. The origins of the definition of African AIDS are quite illuminating. Defining AIDS in Africa Joseph McCormick and Susan Fisher-Hoch were physicians from the U.S. Centers for Disease Control (CDC) who were instrumental in convening 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 immune disorders found among American drug injectors, transfusion recipients, and a cohort of promiscuous urban gay men. There was a tendency for HIV antibodies to react with plasma from these patients. The same was true of blood from Africans afflicted with the diseases of poverty. The infectious viral model of AIDS assumed that immune deficiency would "spread" via HIV to a much larger faction of Africans than those who tested positive for the antibodies. Doctors McCormick and Fisher-Hoch accepted this model, recently explaining their motivation for the Bangui conference and the rationale behind the AIDS definition that resulted from it as follows: "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..."(12) The doctors said they 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."(13) 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."(14) It was upon these grossly unscientific claims, sweeping 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 doctors. "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."(15) As proof that these "AIDS symptoms" were sexually transmitted, McCormick and Fisher-Hoch relied on a narrow survey conducted by Kevin DeCock, another CDC epidemiologist. DeCock examined stored blood samples taken in 1976 (for Ebola virus testing) from 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 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 [emphasis added]."(16) DeCock concluded from these interviews that the dead subjects had died from AIDS, and that HIV had caused their death. 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 either. Had he done this, perhaps he would have discovered that numerous 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 as 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 1970s 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."(17) 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%. (18) These 1997 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 [#30] than into the causes of suicide [#12] or the prevention of road-traffic accidents [#9] and why should this be."(19) Racism and African Sexuality Whereas acquired immune deficiency in the industrialized countries is almost exclusively a disease of a tiny percentage of homosexuals, intravenous drug users and recipients of tainted blood transfusions, AIDS cases in Africa are said to be as general and indiscriminate as such long-time African curses as malaria, schistosomiasis, and sleeping sickness (trypanosomiasis). This is known as the "heterosexual paradox" of AIDS. Proponents of the HIV causation model attempt to explain it in two contradictory ways. Some declare that the paradox is temporary. They speculate that HIV evolved or emerged first in Africa and that, in time, AIDS will be just as rampant in the West. However, they've been saying this now for over fifteen years and nothing of the sort has occurred. Other researchers recognize the permanence of the paradox but account for it by declaring either that Africans are somehow just different from Westerners or are substantially more promiscuous and more likely to have genital ulcers. How else can they explain the widespread distribution of a virus that requires, for non-ulcerated genitals, a thousand heterosexual acts? Such insinuations warrant the closest scrutiny since generalizations about African sexual practices are analytically useless for an internally diversified continent of 650 million people. 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 Université 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." Thus, AIDS "educators" counter "shame" in African sexuality through conservative appeals to restraint, empowerment, negotiating safe sex and a near evangelical insistence on condom use.(20) 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.(21) 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.(22) There are assertions that many African men prefer "dry sex," a practice whereby women, particularly prostitutes, are said to "insert substances, such as household detergents or antiseptics, in their vagina prior to intercourse in order to prevent wetness." According to a recent article in The Lancet, this practice allegedly produces a "hot, tight, and dry" environment, which their men find more pleasurable but which may "increase the risk of HIV-1 transmission, since the substances could cause the disruption of the membranes lining the vaginal and uterine wall."(23) One theory even attributed the origin of HIV to the "repeated radiation exposure of chimpanzees and mangabey monkeys in equatorial Africa" to strontium-90 from uranium mining in the former Belgian Congo and to radiation from atmospheric nuclear tests in the equatorial Pacific Ocean in the 1950s and 1960s after "radioactive fallout from them circled the globe around that latitude."(24) Aside from the voyeurism and the lack of verification that attends these sensationalist claims, no one has ever shown that people in Rwanda, Uganda, Zaire, and Kenya - the so-called "AIDS belt" - are more sexually active than people in Nigeria which has reported only 21,905 AIDS cases out of a population of 120 million or Cameroon which reported 13,576 cases in 14 million.(25) 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 the over-use of antibiotics - the early epidemic of immunological dysfunction among a small sub-culture of urban gay men in the West.(26) The research from Africa suggests nothing of the sort. In 1991 researchers from Médicins Sans Frontières and the Harvard School of Public Health did a survey of sexual behavior in Moyo district of northwest Uganda. Their findings revealed behavior that was 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 had casual sex in the month preceding the study, while 2% of women and 15% of men had done so in the preceding year.(27) 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" or "catastrophe chic" of tabloid journalism enables the media 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."(28) Misery has become a branch of the entertainment industry in Western societies which seem increasingly addicted to representations of violence or distress inflicted on or suffered by other people. British anthropologist Jonathan Benthall suggests that disaster news coverage encourages American and European agencies to maximize their pleas for fund-raising for "humanitarian aid" rather than focus on actual development assistance.(29) Instead, the western media use melancholy metaphors and icons of pity to portray Africans as nameless, helpless wretches which, according to a recent study, only homogenizes complex situations that ironically contributes to public apathy and "compassion fatigue."(30) In the age of globalization, public health seems to require salesmanship, not skepticism. The media's appetite for scary scenarios and their disdain for alternative perspectives enables them to treat Africa in apocalyptic terms.(31) Doomsday scenarios compare AIDS in Africa to the great epidemics in history like the Black Death of the Middle Ages that killed 20 million people.(32) This marketing of anxiety is supposed to promote behavior modification programs that will "save Africa." Some writers seem convinced that the manufacture of fear is not necessarily a bad thing, especially if moral panics help to increase social awareness. For conservatives who want to see "the notion of sexual responsibility [shake] off its puritanical image," the subsequent "public anxiety about AIDS is seen as an important sentiment for popularizing a more restrictive and puritanical sexual ethos."(33) 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."(34) As the momentum behind this assumption continues to gather force, few agencies or scientists dare to question the infectious AIDS hypothesis and leave virtually no room to scrutinize the premises, motives or reliability of its researchers.(35) The serious consequences of claiming that millions of Africans are threatened by AIDS or are already HIV-positive makes it politically acceptable to use the continent as a laboratory for vaccine trials and for the distribution of toxic drugs of disputed effectiveness like ddI and AZT.(36) For instance, AZT is a toxic chemical whose primary biochemical action is the random termination of DNA synthesis; it is monstrous to give such a carcinogenic drug to pregnant women because fetuses cannot develop into babies without DNA synthesis. The catastrophic effects that result from ingesting AZT merit a special place in the medical hall of shame. 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 public health clinics for fear of receiving a "fatal" AIDS diagnosis.(37) 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."(38) 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.(39) Yet Djibouti, Somalia, Egypt, and Sudan, where female genital mutilation is the most widespread, are among the countries with the lowest incidence of AIDS. In Africa, where women contract so-called "Slim Disease" in numbers roughly equal to males, there is no evidence of any correlation between immune deficiency and engagement in promiscuous homosexual intercourse. Intravenous drug use is uncommon among villagers and city dwellers. Does this mean, deductively, that in Africa it is heterosexual intercourse itself that puts everyone at risk for AIDS? Does the "AIDS epidemic" in Africa portend the future of the developed world? Many leading scientists, bio-medical researchers and AIDS experts certainly think this is the case. Biomedical funds that had been earmarked to fight African malaria, tuberculosis and leprosy are now being 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 critical reappraisal of AIDS in Africa must recognize that HIV tests are notoriously unreliable among African populations where antibodies against endemic conventional microbes cross-react to produce ludicrously high false results. For instance, a 1994 study in central Africa reported that the microbes responsible for tuberculosis and leprosy were so prevalent that over 70% of the HIV-positive test results were false. The study also showed that HIV antibody tests register positive in HIV-free people whose immune systems are compromised for a variety of reasons, including chronic parasitic infections and anemia brought on by malaria that are widespread in populations with the diseases of poverty.(40) By definition, all viruses that cause a disease infect over 30% of the cells they target, are present in the blood at concentrations in excess of 10,000 per milliliter, and are contagious. HIV is such a weak retrovirus that when detected at all, it is present in such low concentrations (about one per milliliter) that only its antibodies can be detected. This explains why it is barely transmissible, requiring an average 1000 unprotected vaginal sex contacts with an antibody-positive person for someone to "get" HIV.(41) HIV tests do not detect any virus itself but rather viral antibodies that are read with an assortment of proteins that are not even unique to HIV. One review of the medical literature identified nearly 70 different disease conditions that were documented as capable of triggering a positive result with the test.(42) The so-called "AIDS tests" detect antiviral immunity which is a prognosis against, not for HIV even if such a viral entity exists. The tests fail three basic criteria: they are not specific, there is no standard interpretation of the results, and the results are not reproducible. In a recent study that explained why there is no correlation between a positive HIV antibody test result and the isolation of HIV itself, the authors concluded that "the use of HIV antibody tests as predictive, diagnostic and epidemiological tools for HIV infection needs to be carefully reappraised."(43) Another investigation reported that even if HIV-1 is detected in the blood or cervical secretions of an HIV-seropositive woman, "the amount of HIV-1 excreted in the cervicovaginal fluid is independent of the quantity of virus present in the blood cells or plasma."(44) Richard Strohman, Professor Emeritus of Molecular Biology at University of California (Berkeley), points out that "HIV science has always been based not on detection of real infectious units (real virus) growing under some reasonable standard condition in living cells in the lab. Rather it is based upon a high tech series of assays constructed so that disappearingly small quantities of the virus, or some part of the virus, or some trace (aura) of viral presence may be measured. We have substituted the measurement for the real thing, like substituting the menu for the meal."(45) The association of HIV antibody tests with ordinary infections does not mean that a positive result warrants a prognosis of death, an effect that would defy all classical experience with viruses, microbes and antibodies. According to Dr. Valendar Turner of Royal Perth Hospital (Western Australia), the ELISA and Western Blot tests indicate that "some antibodies in patients react with some proteins in the culture of tissues from the same patients" but with "the total absence of proof of their specificity."(46) In other words, the tests detect proteins that are alleged to form the components of such an antibody but have never been shown to be unique to a virus. The packet insert in an HIV/ELISA test from Abbott Laboratories contains this prudent disclaimer: "At present there is no recognized standard for establishing the presence or absence of antibodies to HIV-1 in human blood."(47) Consider an investigation, reported in The Lancet, of 9,389 Ugandans with HIV antibody test results. 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" 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.(48) Dr. Turner points out that, according to the CDC, an African "with an AIDS defining diagnosis is counted as heterosexual AIDS simply by the fact that he or she comes from a country where heterosexual AIDS is claimed to be the 'predominant' mode of transmission. Knowledge of actual sexual contact is not a requirement."(49) In a highly touted 1995 report on the Mwanza region of Tanzania, it was precisely the absence of such knowledge that allowed the researchers to claim that "improved STD treatment reduced HIV incidence by about 40%...[in] the first randomized trial to demonstrate an impact of a preventive intervention on HIV incidence in a general population." This occurred despite the fact that "no change in reported sexual behavior was observed in either group." On closer inspection of the data, one realizes how the 40% reduction was measured. Of the individuals who initially tested HIV-negative, in the intervention group 48 out of 4149 (1.2%) were HIV-positive two years later; 82 of 4400 (1.9%) in the comparison group tested HIV-positive. The researchers arrived at the "40% reduction" figure merely by calculating the difference between 1.2% and 1.9%.(50) The Africans in this study had tested positive or negative for antibodies to HIV but the source of their "infection" was unknown. While the research suggested that a regimen of antibiotics reduced the prevalence of HIV-antibodies in patients, the investigators emphatically maintained, with no direct evidence whatsoever, that their intervention had somehow reduced the transmission.(51) The results of a largely clinical trial in a Ugandan population, reported in The Lancet, showed that despite a reduction in sexual transmitted diseases, there was no difference in HIV-antibody incidence between the treated and untreated populations or in pregnant women. Among the 15,127 participants in the study in Rakai District, Uganda, the "incidence rates of HIV-1 did not differ between intervention and control subgroups based on age, sex or marital status, among partners in HIV-1 discordant or HIV-1 concordant relationships, or among individuals reporting single or multiple partners..."(52) Moreover, the findings suggested that while "the mass-treatment strategy [consisting of azithromycin, ciproflaxacin and metronidazole] significantly decreased the rate of maternal cervical and vaginal infections during pregnancy, [there was] no concomitant reduction in incidence of HIV-1 infection either during pregnancy or after delivery."(53) AIDS researchers in Africa assume there is a correlation between clinical symptoms (weight loss, chronic diarrhea, fever, a persistent dry cough) and sexual activity. Correlation - whether one phenomenon is found in tandem with another - is not causation. Proof of causation requires that we control all variables in order to isolate one variable as a cause, not merely an associated factor. The clinical symptoms that define an AIDS case in Africa are expressed in roughly equal numbers among men and women, not because of alleged heterosexual transmission, but because the socio-economic conditions that give rise to the gender equity in the distribution of these widespread symptoms are caused by environmental risk factors to which many Africans are regularly exposed.(54) Poverty-stricken, malnourished subsistence farmers with malaria, tuberculosis or repeated attacks of dysentery are likely to have a considerable amount of cross-reacting antibodies in their systems. Dr. F.J.C. Millard, a physician at a small mission hospital in South Africa's North Province (formerly Northern Transvaal), described the local conditions in which the incidence of tuberculosis and AIDS were rising: "the area had suffered from neglect during the apartheid years. There is poverty, malnutrition, violence, unemployment, overpopulation, and, most important of all, a lack of education."(55) If it is not the sexual transmission of HIV, then what causes the widespread appearance of AIDS symptoms throughout Africa? The evidence strongly implicates that ordinary, widespread socio-economic conditions give rise to AIDS symptoms even among HIV-negative Africans. A literature review in the World Journal of Microbiology and Biotechnology pinpointed the methodological flaw in the belief that AIDS is sexually transmissible: "Since AIDS is a panoply of diseases or symptoms and signs, the minimum requirement to prove that AIDS is spread by sexual activity is to take an index case, isolate the putative agent, trace the sexual contacts of that case, and then isolate the same agent. To date, no data anywhere of this type has ever been presented either in Africa, or anywhere else. In the whole history of medicine there has never been an example of a sexually transmitted disease which is spread unidirectionally, and certainly not one that is spread unidirectionally in one country and bidirectionally in another. Indeed, given this and the other differences between AIDS in the West and Africa, it is necessary to postulate that HIV must possess unique features...[and] be able to distinguish the gender and country of residence of its host. The only other alternative is to agree with African physicians that positive HIV antibody tests in Africa do not mean infection with HIV and that immnuosuppression and certain symptoms and diseases which constitute African AIDS have existed in Africa since time immemorial."(56) Nor is there evidence of widespread secondary or tertiary transmission of HIV or AIDS among heterosexuals in the West either. "This is an important point to consider," warns AIDS researcher Michelle Cochrane, "because the foundation of orthodox AIDS science and epidemiology rests upon the premise that HIV/AIDS is relatively frequently transmitted from an index AIDS case (the primary individual) to a secondary AIDS case either through an exchange of semen or blood. In turn, this secondarily 'infected' individual must be capable of transmitting HIV/AIDS to a third individual (tertiary transmission) by the same means, or an infectious disease epidemic cannot be sustained."(57) In her meticulous doctoral dissertation, 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 healthcare and prevention services."(58) Cochrane's thesis is a case study of the creation of a bureaucracy for AIDS surveillance in San Francisco. Orthodox surveillance knowledge of AIDS in San Francisco played a key role in constructing a global consensus on AIDS historiography and science. According to Cochrane, this knowledge displays a remarkable coherence and internal consistency that is marshaled to refute any criticism of its assumptions about the etiology, epidemiology and history of AIDS. The AIDS Seroepidemiology and Surveillance Branch in San Francisco constitutes the greatest repository in the world for primary documentation on AIDS. It includes the medical charts and case files for every one of the 25,221 AIDS patients cumulatively reported since 1981 in the city. Cochrane demonstrates how the vested interests of research institutions, AIDS organizations and activist individuals perpetuated the conventional consensus that HIV causes AIDS, "a conclusion which persists despite the presence of multiple lacunae or anomalies that the theory has not resolved."(59) 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 sufficient for such a woman "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 [heterosexual] female AIDS cases [out of 25,221 cumulative cases in San Francisco] attributed to sexual transmission would, 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."(60) 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.(61) This may reflect a so-called "unholy alliance" between epidemiology, professional journals and the media. Harvard epidemiologist Alex Walker acknowledges that it only takes a handful of papers before a suspected association "springs into the general public consciousness in a way that does not happen in any other field of scientific endeavor."(62) According to a researcher from the National Institute of Environmental Health Sciences, "investigators who find an effect get support, and investigators who don't find an effect don't get support. When times are tough it becomes extremely difficult for researchers to be objective."(63) These are critical points to consider when reviewing the epidemiological data on AIDS cases or HIV seroprevalence anywhere in Africa.(64) For the period 1984-97, the WHO compared estimates of HIV seropositivity with the actual numbers of AIDS cases in its Weekly Epidemiological Reports. The cumulative result is that 99.2% 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 AIDS infections. A study on Uganda, reported in The Lancet, alleged that "a reduction in births to HIV-infected mothers will affect demographic projections of the future numbers of AIDS orphans, as well as projections of the impact of HIV-1 on population growth."(65) In 1987, the WHO estimated that 1 million Ugandans were HIV-positive. Ten years later, that number was unchanged yet the cumulative total of AIDS cases reported in Uganda was less than 55,000.(66) Researchers did not know the health status of the other 945,000 HIV-positive Ugandans who were not AIDS cases nor evidently noticed the erroneous projections and obvious discrepancies that appeared among articles published in the very same journal. 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 thirteen years, as the external financing of HIV-based AIDS programs in Africa dramatically increased, money for studying other health sectors remained static, even though deaths from malaria, tuberculosis, neo-natal tetanus, respiratory diseases and diarrhea grew at alarming rates.(67) While western health leaders fixate on HIV, approximately 52% of sub-Saharan Africans do not have access to safe water, 62% have no proper sanitation, almost half live on less than one dollar a day, and an estimated 50 million pre-school children suffer from protein-energy malnutrition.(68) 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 are the primary threats to African lives.(69) When essential services for water, power, and transport break down, public sanitation deteriorates and the risks of cholera, tuberculosis, dysentery, and respiratory infection increase. Historian Randall Packard documented the attempts by the South African government to control the spread of tuberculosis and to lower tuberculosis morbidity and mortality rates. Even though tuberculosis is curable and the available control measures are sufficient to combat it effectively with antitubercular drugs, the apartheid government made little impact on the overall prevalence of the disease. Packard showed that the South African government was unwilling "to address the foundations of black poverty, malnutrition, and disease upon which the current [1980s] epidemic of tuberculosis is based...[and] placed their faith in the ability of medical science to solve health problems in the face of adverse social and economic conditions."(70) By the mid-1990s, AIDS researchers and policy makers confused correlation with causation as they conflated tuberculosis incidence and the reactivation of dormant TB with HIV-antibody status. This co-mingling enabled conventional AIDS programs to link efforts to reduce the infectiousness and severity of tuberculosis with family planning, safe sex messages and behavior modification proposals.(71) In August 1998, the New York Times reported that Zimbabwe had become "the center of the world's AIDS epidemic." It claimed that as many as 25 percent of all adult Zimbabweans may be infected with HIV, the highest infection rate on earth. Although it provided no figures for previous years, the article acknowledged that the presumed increase in HIV incidence had occurred when increasing poverty, food shortages and instability had "begun to overcome the country. Tuberculosis, hepatitis, malaria, measles and cholera...have surged mercilessly. So have infant mortality, stillbirths and sexually transmitted diseases." Malarial deaths had risen from 100 in 1989 to 2,800 in 1997 and tuberculosis cases jumped from 5,000 in 1986 to 35,000 in 1997. The reporter admitted these diseases were all indicative of deepening poverty, calling TB "the sentinel illness of poverty and social decline."(72) Other articles in the macabre series, entitled "Dead Zones," illustrate a fundamental flaw in the HIV/AIDS model. Among sick or dying Africans, clinicians cannot distinguish who would test antibody-positive even if test kits were available. AIDS diagnoses are made presumptively. People are diagnosed as having AIDS simply by having the conditions that HIV is said to cause, such as tuberculosis or the symptoms of malaria (persistent night sweats, fever, wasting) or that of cholera (diarrhea, fever, wasting). Former WHO Director General Hiroshi Nakajima warned emphatically that "poverty is the world's deadliest disease."(73) 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 the trace measurements of antibodies for a mysterious virus that has proved difficult or impossible to isolate directly, even from AIDS patients. The so-called "AIDS epidemic" in Africa is being used to justify the medicalization of sub-Saharan poverty. Rather than treat the clinical symptoms of AIDS as the manifestations of impoverished living conditions, researchers like Dr. David Alnwick, UNICEF's health chief, invert the cause-and-effect relationship to allege that "all our efforts at providing safe water and other protections for children have been undermined, undone, by the AIDS epidemic."(74) Thus, Western medical intervention takes the form of vaccine trials, drug testing, and evangelistic demands for behavior modification by safe sex missionaries.(78) In 1997, the Division of AIDS at the National Institute of Allergy and Infectious Diseases concluded that there was "not enough evidence that a live attenuated HIV-1 vaccine [was] safe - or effective." Nonetheless, the International Association of Physicians in AIDS Care (IAPAC) insisted that it was wrong to require a vaccine to meet U.S. safety and efficacy standards because the alleged number of AIDS cases rendered "further delay unethical."(76) According to the International AIDS Vaccine Initiative, "$500 million in vaccine research is needed to encourage drug companies to move toward the eventual goal of profiting from AIDS vaccines, not just drugs to treat the epidemic."(77) When a United Nations panel termed American medical and testing standards a form of "cultural imperialism" that should not be imposed on African countries, Dr. Peter Piot (head of the UNAIDS Program), in an astonishing reversal, endorsed the recommendation which he welcomed as a "shift from older attitudes of paternalism and protectiveness to greater empowerment by developing countries."(78) AIDS scientists and public health planners should recognize the role of malnutrition, poor sanitation, anemia, and parasitic and endemic infections in producing the clinical AIDS symptoms that are manifestations of non-HIV insults.(79) The data strongly suggest that socio-economic development, not sexual restraint, is the key to improving the health of Africans. Wherever one projects high rates of HIV-antibodies in Africans, one also finds high rates for all germs indicative of sanitation problems which in turn indicate abject poverty, destitution and a high disease burden, rather than HIV run amok. Phillipe and Evelyn Krynen, medically trained charity workers employed by the French group Partage in Kagera Province (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."(80) A similar observation came 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."(81) And a 1998 study of pregnant, HIV-positive women in Tanzania showed that simply providing them with inexpensive micronutrient supplements produced beneficial effects and decreased adverse pregnancy outcomes. 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." Their commitment to the belief that "AIDS" was caused by a viral infection, obliged the researchers to conclude that "how the individual vitamins produce these effects is not fully understood."(82) 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 social scientists should familiarize themselves with the growing body of literature that demonstrates the contradictions, anomalies and inconsistencies in the orthodox view that AIDS is caused by a viral infection.(83) Once they consider the non-contagious explanations for AIDS cases in Africa, they can help stop the relentless proliferation of terrifying misinformation that associates sexuality with death. Endnotes 1.       Colin Bundy, "Great Expectations? The University in Society" (March 25, 1998), quoting Ronald Barnett, Higher Education: A Critical Business (London: Open University Press, 1997), p. 5. 2.        Margo Russell and Mary Mugyenyi, "Armchair Empiricism: A Reassessment of Data Collection in Survey Research in Africa," African Sociological Review, Vol. 1, #1 (1997), pp. 16-29. 3.        "New Term for 'People Living with HIV'," The Star (July 4, 1997). See also Alan Whiteside, et. al., The Impact of HIV/AIDS On Planning Issues in KwaZulu-Natal (Pietermaritzburg: Town and Regional Planning Commission, 1995); and Douglas Webb, HIV and AIDS in Africa (Pietermaritzburg: University of Natal Press, 1997). Dr. Alan Whiteside of the University of Natal, a leading AIDS researcher, confirmed that he "totally agreed" with me "that the data on AIDS cases is unreliable." He added that "the situation is so bad in South Africa that we have currently stopped collecting information on actual AIDS cases until such time as we can develop a way of collecting it so that it is meaningful." Whiteside to Geshekter, personal correspondence, 6 October 1997. 4.        UNAIDS and World Health Organization, Report on the Global HIV/AIDS Epidemic (Geneva: UNAIDS/WHO, June 1998) 5.        World Health Organization, Weekly Epidemiological Record, Vol. 73 (27 November 1998), p. 373 (Table #48). 6.        World Health Organization, The World Health Report 1998: Life in the 21st Century, A Vision for All (Geneva: WHO, 1998), Table A3, Basic Indicators, pp. 228-231. 7.        Paul Kelly, et. al., "High Adult Mortality in Lusaka," The Lancet, Vol. 351 (March 21, 1998), p. 883. 8.        South African Medical Journal, Vol. 88, #3 (March 1998). Moreover, the Vice-President of the Indian National Science Academy, Dr. M.S. Valiathan recently disputed future projections of AIDS cases in India: "but are they correct - 20 million cases, 50 million cases? I don't accept these figures. The data come from just a few 'sentinel' laboratories who monitor samples from blood donors and sexually transmitted diseases; and the results are then extrapolated to the whole population of 900 million." The Lancet, Vol. 351, (April 25, 1998), p. 1271. 9.        Charles F. Gilks, "What Use is a Clinical Case Definition for AIDS in Africa?" British Medical Journal, Vol. 303 (November 9, 1991), pp. 1189-90. 10.     Nancy Padian, et. al., "Heterosexual Transmission of Human Immunodeficiency Virus (HIV) in Northern California: Results from a Ten-Year Study," American Journal of Epidemiology, Vol. 146, #4 (August 15, 1997), pp. 350-57. 11.     Recent research among African populations suggests that a person with an over-active immune system that is constantly assaulted by various pathogens or burdened with chronic infections is more susceptible to a positive HIV antibody test result. Zvi Bentwich, et. al., "Immune Activation is a Dominant Factor in the Pathogenesis of African AIDS," Immunology Today, Vol. 16, #4 (1995), pp. 187-91. 12.     Joseph B. McCormick and Susan Fisher-Hoch, Level 4: Virus Hunters of the CDC (Atlanta: Turner Publishing, 1996), pp. 188-90. 13.     Ibid., p. 176. 14.     Ibid., pp. 173-74. 15.     Ibid., pp. 179-80. 16.     Ibid., p. 193. 17.     Henry M. Kitange, et. al., "Outlook for Survivors of Childhood in Sub-Saharan Africa: Adult Mortality in Tanzania," British Medical Journal, Vol. 312 (January 27, 1997), pp. 216-17. The authors report that "a network of people was established in each of the [Tanzanian] study areas whose responsibility it was to inform a field supervisor of all deaths occurring in their areas. Locally known and respected people were selected...when a death was reported, the field supervisor in that area visited the home of the deceased and carried out a 'verbal autopsy.' This entailed interviewing the family by using a standard proforma with the aim of determining the cause of death." 18.     Christopher Murray and Alan Lopez, "Mortality by Cause for Eight Regions of the World: Global Burden of Disease Study," The Lancet, Vol. 349 (May 3, 1997), pp. 1269-1276. In a prudent understatement, the authors advise that "the system of collecting cause of death data via 'verbal autopsies' needs to be assessed and improved to provide reliable data on broad categories of causes of death at low cost." 19.     "From What Will We Die in 2020?" The Lancet, Vol. 349 (May 3, 1997), p. 1263. 20.     Jean-Yves Nau, "AIDS Epidemic Far Worse Than Expected," Le Monde section in Manchester Guardian Weekly (December 14, 1993). Jack Goody claims that love is a consequence of modernity and written culture so that when liyteratte poeple are seperated by social barrier or absence they write to each other using precise words that lead them to be analytical and reflexive, eventually coming to act as they write; African oral cultures, however, had little elaboration of romantic love in art, discourse or actuality. Some AIDS researchers like Klumeck evidently accept Goody's analysis to suggest why Africans are more disposed to spread AIDS through heterosexual activity. Jack Goody, Food and Love: A Cultural History of East and West (London: Verso, 1999). 21.     For an example of anecdotes and impressionistic tales disguised as "facts" about East African truck drivers and AIDS, see Ted Conover, "Trucking Through the AIDS Belt," The New Yorker (August 16, 1993). 22.     Raul Sebastian, "Did AIDS Start in the Jungle?" The Lancet, Vol. 348 (November 16, 1996), p. 1392. 23.     Adele Baleta, "Concern Voiced Over 'Dry Sex' Practices in South Africa," The Lancet, Vol. 352, No. 9136, (October 17, 1998), p. 1292. 24.     Brandon P. Reines, "Radiation, Chimpanzees and the Origin of AIDS," Perspectives in Biology and Medicine, Vol. 39, #2 (Winter 1996), pp. 187-92. 25.     World Health Organization, Weekly Epidemiological Record, Vol. 72, #48 (November 28, 1997), p. 357. 26.     In a review of Sexual Ecology: AIDS and the Destiny of Gay Men by Gabriel Rotello (New York: Dutton, 1997) and Life Outside: The Signorile Report on Gay Men by Michelangelo Signorile (New York: HarperCollins, 1997), Professor Daniel Kevles notes that with the advent of gay liberation, "bathhouses, while offering a communitarian haven from homophobia, also institutionalized part of the liberation movement, providing sexual opportunities in private cubicles, showers, hallways, and dimly lit 'orgy rooms' devoted to anonymous encounters...Tens of thousands were habitués of the 'circuit' - a series of large gay dance parties held in different places where they used one kind of drug to heighten their sexual energies and another to relax their sphincter muscles." Daniel J. Kevles, "A Culture of Risk," New York Times Book Review (May 25, 1997), p. 8. John Lauritsen and Dr. Joseph Sonnabend have described the unhealthy lifestyle of this very specific cohort of urban gay men in the United States who had unprecedented opportunities for sexual contacts with hundreds, even thousands of partners. It was a ghettoized sub-culture of "fast track" gay men who habitually abused alcohol and drugs that produced the epidemic levels of chronic infection and immunological breakdown that allowed opportunistic infections to take over bodies that had been repeatedly exposed to a wide range of microbes such as gonorrhea, cytomegalovirus, hepatitis, syphilis, non-specific viral infections, bacterial pathogens, and parasitic infections. Without addressing these underlying socio-economic and environmental causes, the commitment of researchers to lump together the diverse cases of immune-deficiency that began appearing in this sub-culture led them uncritically to accept the unifying hypothesis of a single viral cause based on the similarities of the disease manifestations. See Joseph Sonnabend, "Fact and Speculation About the Cause of AIDS," AIDS Forum, Vol. 2, #1 (May 1989), pp. 2-12; John Lauritsen, The AIDS War (New York: Asklepios Press, 1993); and John Lauritsen and Ian Young (eds.) The AIDS Cult: Essays on the Gay Health Crisis (Provincetown, Massachusetts: Asklepios Press, 1997). A recent New York Times article by Frank Bruni, "Drugs Taint Annual Gay Revels" (September 8, 1998) chronicled the abundant array of drugs like cocaine, Ecstasy, ketamine ("special K") and a liquid anesthetic called gamma hydroxybutyrate (GHB) that were widely consumed at an August 1998 fund-raiser for AIDS at Fire Island, New York. 27.     Doris Schopper, Serge Doussantousse, and John Orav, "Sexual Behaviors Relevant to HIV Transmission in a Rural African Population," Social Science and Medicine, Vol. 37, #3 (August 1993), pp. 401-12. 28.     James Deane, "The Role of the Media in the Fight Against AIDS," SIDAfrique, #8/9 (1996), p. 29. 29.     Jonathan Benthall, Disasters, Relief and the Media (New York: St. Martins Press, 1993). For a demonstration of how U.S. officials manipulated statistics and public fears in a decades-long pattern to mobilize billions of dollars in a futile effort to halt the illicit international drug trade, see Mike Gray, Drug Crazy (New York: Random House, 1999). David Ignatius, in his Washington Post column (September 15, 1999), identifies what he calls our tendency towards "sequential hysteria," the phenomenon in which a problem is well recognized long before it reaches a critical stage, then for a few brief days it becomes Topic A, but then before long it's back to inattention, all without anything ever really being done about it. Ignatius gives as examples the Russian corruption scandal, Chinese atomic espionage, the FBI at Waco, the North Korean nuclear threat, and genocide in Africa. A good point, but marred when Ignatius, trying to tie up his column too neatly with a bow made from the day's news, adds Hurricane Floyd to his list. The problem is Floyd hasn't been known about for a long time and things are really being done in reaction to it. 30.     Susan D. Moeller, Compassion Fatigue: How the Media Sell Disease, Famine, War and Death (New York: Routledge, 1998). 31.     A typical example is Lawrence K. Altman, "Parts of Africa Showing HIV in 1 in 4 Adults," New York Times (June 24, 1998) 32.     For a scholarly attempt to analogize AIDS with the Black Death, see David Herlihy, The Black Death and the Transformation of the West (Cambridge, Harvard University Press, 1997), pp. 5-6. 33.     Frank Furedi, Culture of Fear (London: Cassell, 1997), p. 48. 34.     "No End of Plagues," The Economist (September 7, 1996), p. 38. A recent study found that 40% of American journalists rarely or never seek independent verification for a science story they are writing, and 82% of the scientists polled felt that journalists did not understand statistics well enough to explain new findings. Jim Hartz and Rick Chappell, Worlds Apart: How the Distance Between Science and Journalism Threatens America's Future (Nashville: First Amendment Center at Vanderbilt University, 1998). As Will Rogers once noted, it's not ignorance that is so bad, "it's all the things we know that ain't so." 35.     Nowhere is this more evident than at the biennial "International AIDS Conferences" which have come to resemble pharmaceutical trade shows for commodities of the AIDS industry. At the XII AIDS Conference (Geneva, June 1998), the media and researchers referred to AIDS as a "runaway epidemic" and a "collective failure of the world," demanding that it be made a "global public health priority." Lawrence Altman, "At AIDS Conference, a Call to Arms Against 'Runaway Epidemic'," New York Times (June 29, 1998) 36.     In June 1998, several major companies offered to discount the cost of drugs to Africans. Glaxo Wellcome cut the price of AZT and 3TC to $200 a month for sale in Uganda and Ivory Coast where the annual per capita income is less than the price of the drug! Urging African governments to subsidize the costs, UN official Joseph Saba said his agency had to "show them that AIDS justifies investing public finds." Associated Press, "Firms Cut AIDS Drug Prices to 3rd World," San Francisco Chronicle (June 24, 1998) 37.     For instance, a 31-year old man in Kagera Province (Tanzania) was said to be dying of AIDS. Emaciated and despondent, he worked as a fisherman until he became sick in 1992 with diarrhea, chest pains, muscle weakness, and a severe cough. The man stayed with an aunt because his brother and sister refused to see him. "Since I became sick," he told a reporter, "I have not made an effort to go to the hospital because I have no money and my aunt is not able to pay." Susan Okie, "Tanzania Village Devastated by AIDS Deaths," Washington Post (March 15, 1992) 38.     "False-Positive Self-Reports of HIV Infection," letter from Chifumbe Chintu, et. al., The Lancet, Vol. 349 (March 1, 1997), p. 649. 39.     Thomas Bass, Reinventing the Future: Conversations with the World's Leading Scientists (Reading, Massachusetts: Addison-Wesley, 1994), p. 40. See also the analysis by a Sudanese anthropologist, Rogaia Mustafa Abusharaf, "Unmasking Tradition," The Sciences (March/April 1998), p. 24. 40.     Oscar Kashala, et. al. "Infection with HIV-1 and Human T Cell Lymphotropic Viruses Among Leprosy Patients and Contacts...," Journal of Infectious Diseases, Vol. 169, (February 1994), pp. 296-304. 41.     I. de Vicenza, "European Study Group on Heterosexual Transmission of HIV," New England Journal of Medicine, Vol. 331, 1994, pp. 341-46. Moreover, recent research showing that male to female transmission of HIV was infrequent during natural conception was also "compatible with seroconversion rates in the order of 1 per 1000 episodes of unprotected intercourse reported in longitudinal studies of stable heterosexual couples as well as in studies of transmission through artificial insemination." L. Mandelbrot, I. Heard, E. Henrion-Geant and R. Henrion, "Natural Conception in HIV-Negative Women with HIV-positive Partners," The Lancet, Vol. 349 (March 22, 1997), pp. 885-89. 42.     Christine Johnson, "Factors Known to Cause False-Positive HIV Antibody Tests," Zenger's Magazine (September 1996), pp. 8-9; Neville Hodgkinson, "The World AIDS Conference," The European (June 22, 1998). 43.     Eleni Papadopulos-Eleopulos, et. al., "Is A Positive Western Blot Proof of HIV Infection?" Bio/Technology, Vol 11 (June 1993), pp. 696-707. See also, Eleni Papadopulos-Eleopulos, et. al., "HIV Antibodies: Further Questions and a Plea for Clarification," Current Medical Research and Opinion, Vol. 13, #10 (1997), pp. 627-34. 44.     Suraiya Rasheed, et. al., "Presence of Cell-Free Human Immunodeficiency Virus in Cervicovaginal Secretions is Independent of Viral Load in the Blood of Human Immunodeficiency Virus-Infected Woman," American Journal of Obstetrics and Gynecology, Vol. 175, #1 (July 1996), p. 123. 45.     Richard Strohman to Charles Geshekter, e-mail message, July 7, 1997. 46.     "Do Antibody Tests Prove HIV Infection? - Interview with Dr. Valendar F. Turner," Continuum, Vol. 5, #2 (Winter 1997), p. 13. See also, Eleni Papadopulos-Eleopulos, et. al., "A Critical Analysis of the HIV-T4-cell-AIDS Hypothesis," Genetica, Vol. 95, No. 1-3 (1995), pp. 5-24. Furthermore, a growing number of studies indicate little correlation between AIDS symptoms and either T-cell counts or viral load. In fact, no one can say with certainty what these "indicators" mean. One critical report concluded that the accuracy of CD4 cell counts for AIDS was "as uninformative as a toss of a coin." Thomas R. Fleming and David L. DeMets, "Surrogate End Points in Clinical Trials: Are We Being Misled?" Annals of Internal Medicine, Vol. 125, #7 (October 1, 1996), pp. 605-13. 47.     HIV-1/HIV-2 (Recombinant Antigens and Synthetic Peptides), May 1998, p. 6. 48.     Daan W. Mulder, et. al., "Two-Year HIV-1-associated Mortality in a Ugandan Rural Population," The Lancet, Vol. 343 (April 23, 1994), pp. 1021-23. 49.     "Interview with Dr. Valendar Turner," op. cit., p. 17. 50.     Heiner Gosskurth, et. al. "Impact of Improved Treatment of Sexually Transmitted Diseases on HIV Infection in Rural Tanzania: Randomized Controlled Trial," The Lancet, Vol. 346, (August 26, 1995), pp. 530-36. The researchers maintained that their trials were "designed to test whether improved STD services have an impact on HIV-1 transmission. The intervention was not designed to change sexual behavior; it is therefore not surprising that no such change was observed." See correspondence from Heiner Gosskurth, et. al., The Lancet, Vol. 351 (March 28, 1998), p. 990. 51.     The a priori assumptions of the research team were confirmed in a written exchange with Richard Hayes (London School of Hygiene and Tropical Medicine), the corresponding author for the research group. On October 14, 1996, I sent a series of questions to Hayes asking him to clarify the group's findings. I reproduce here two of my questions and Hayes' responses on March 14, 1997: o        CG: "Among the twelve village health centers on or near Lake Victoria where "annual HIV incidence" was 1%, what techniques did researchers use to distinguish between the incidence or prevalence of HIV and the transmission of HIV? What method was used to determine that HIV was actually "spreading" or that the incidence of new cases had decreased?" o        RH: "We measured the incidence of HIV infection by following up a random sample of adult residents over two years. The annual incidence is the proportion of seronegative subjects who seroconvert, divided by two (because of the two-year follow-up period). In the 'comparison communities' (which did not receive the improved STD services), 1.9% seroconverted over two years, giving an annual incidence of about 1% as stated. In the 'intervention communities' (which did receive the improved services) only 1.2% seroconverted, so the incidence of new infections was about 40% lower, presumably as a result of the intervention." o        CG: "There was no discernible difference in the reported sexual behavior or frequency of condom use in the intervention and control communities. While the intervention of drug therapies may have played a role in reducing HIV seroprevalence, what would that necessarily suggest about HIV transmission? " o        RH: "Transmission implies the occurrence of new cases as the virus is spread from one individual to the next. This is measured as the 'incidence' of new infections, as explained above, and our results showed a clear effect of the intervention on incidence. We assume the explanation for this is that it is much easier for the HIV virus [sic] to be transmitted from one sexual partner to the other if one of them has another STD (this is the so-called STD Cofactor Effect). By treating STDs promptly and effectively, you should be able to reduce their duration and hence prevalence, so that it becomes much more difficult for the HIV virus to be transmitted." 52.     Maria J. Wawer, et. al., "Control of Sexually Transmitted Disease for AIDS Prevention in Uganda: A Randomized Community Trial," The Lancet, Vol. 353 (February 13, 1999), p. 531. 53.     Ibid., p. 532. 54.     For a small sample of articles that uncritically apply the contagious HIV/AIDS theory to Africa, see: John C. Caldwell and Pat Caldwell, "The African AIDS Epidemic," Scientific American (March 1996), pp. 62-68; Simon Gregson, "Will HIV become a Major Determinant of Fertility in Sub-Saharan Africa?" Journal of Development Studies, Vol. 30, #3 (April 1994), pp. 650-79; and Kelly Lee and Anthony B. Zwi, "A Global Political Economy Approach to AIDS: Ideology, Interests and Implications," New Political Economy, Vol. 1, #3 (1996), pp. 355-73. A good example of its application to South Africa is Greg Wood and Barbara Mason, The Impact of HIV/AIDS on Orphaned Children in KwaZulu-Natal (Pietermaritzburg: Children in Distress/CINDI, December 1997). 55.     F.J.C. Millard, "South Africa: A Physician's View," The Lancet, Vol. 351 (March 7, 1998), p. 748. 56.     Eleni Papadopulos-Eleopulos, Valendar Turner, J. Papadimitrou and H. Bialy, "AIDS in Africa: Distinguishing Fact from Fiction," World Journal of Microbiology and Biotechnology, Vol. 11 (March 1995), pp. 141-42. 57.     Michelle Cochrane, "The Social Construction of Knowledge on HIV and AIDS: With a Case Study on the History and Practices of AIDS Surveillance Activities in San Francisco," Ph.D. dissertation, Department of Geography, University of California, Berkeley, April 1997, p. 253. 58.     Ibid., p. 7. 59.     Ibid, pp. 322-24. 60.     Ibid., pp. 259-60. The latest AIDS Surveillance Report from the San Francisco Department of Public Health (April 1998), reports that over the past 17 years, a cumulative total of 243 heterosexual female AIDS cases have been reported out of 25,221 AIDS cases in San Francisco - less than 1%. 61.     Robert T. Michael, John H. Gagnon, Edward Laumann and Gina Kolata, Sex in America: A Definitive Survey (Boston: Little, Brown and Company, 1994) reached similar conclusions. Despite a decade of dire warnings that everyone was at risk, few Americans changed their sexual behavior yet AIDS cases did not spread. The authors showed that "AIDS is, and is likely to remain, confined to exactly the risk groups where it began: gay men and intravenous drug users and their sexual partners." Convinced that "there is not and very unlikely ever will be a heterosexual AIDS epidemic in this country," they acknowledged that it could be "more difficult to raise research funds for a disease that is not a threat to most Americans," but insisted it was "better to tell the truth than to behave like scaremongers, telling the country that a disaster will soon strike us all, no matter what the data say." (pp. 216-18). 62.     Gary Taubes, "Epidemiology Faces its Limits," Science, Vol. 269 (14 July 1995), p. 169. 63.     Loc cit. 64.     For instance, even though South Africa reported only 1,120 AIDS cases in 1995 but 90,292 cases of tuberculosis in 1994, AIDS was accorded a much higher national profile and larger budget so that it now dominates clinical practice across all medical fields ranging from pediatrics to neurology. World Health Report 1996, p. 130; "South Africa: Country Profile," The Lancet, Vol. 349 (May 24, 1997), p. 1542. Oddly enough the 1998 World Health Report indicated only 729 AIDS cases in South Africa for 1996 - a decrease of 35% from 1995! 65.     Ronald H. Gray, et. al., "Population-Based Study of Fertility in Women with HIV-1 Infection in Uganda," The Lancet, Vol. 351 (January 10, 1998), p. 102. 66.     Dilys Morgan, et. al., "HIV-1 Disease Progression and AIDS-Defining Disorders in Rural Uganda," The Lancet, Vol. 350 (July 26, 1997), p. 245. 67.     World Health Organization, Bridging the Gaps: The World Health Report 1995 (Geneva: WHO, 1995), Table 5 (p. 18) and Table A3 (p. 110); and World Health Organization, Fighting Disease, Fostering Development: The World Health Report 1996 (Geneva: WHO, 1996), Table 4 (p. 24) and Table A3 (p. 127). 68.     "A Good Turn for Africa, Please," The Lancet (January 11, 1997), p. 69. The continent seems to grow poorer with every passing decade, leading a recent analysis to suggest that, "even if Africa's aggregate growth doubles over the next nine years, its per capita income in 2006 would still be five percent lower than it was in 1974." Dan Connell and Frank Smyth, "Africa's New Bloc," Foreign Affairs, Vol. 77, #2 (March/April 1998), p. 89. In Uganda, the spending on debt servicing ($15 per head annually) is six times the spending on health and nearly one in two children is undernourished.