AIDS AND AFRICA:A CASE OF RACISM VS SCIENCE?

Western scientists have promoted the hypothesis that the AIDS epidemic began in Africa, arguing that either AIDS had existed for many years in an African "lost tribe" or that a retrovirus crossed the species barrier from monkey to man. The scientific evidence in support of this hypothesis has included AIDS-like cases from Africa that predated the epidemic in the West, seroepidemiological evidence for early African infection, and the isolation of retroviruses from African monkeys considered similar to the human immunodeficiency virus. Yet when the scientific literature supporting an African origin is examined it is found to be contradictory, insubstantial or unsound, whilst the possibility that AIDS was introduced to Africa from the West has not been seriously investigated. The belief that the AIDS epidemic originated in Africa has also distorted Western perceptions of the scale and mode of spread of the epidemic in Africa, and it would seem that much of the research into AIDS and Africa has been influenced by racism and not science.

The Acquired Immune Deficiency Syndrome (AIDS) was first recognised as a clinical entity in 1981 in the United States,(1) and although the majority of cases even today have been reported from the United States,(2) the Western scientific community has convinced the world that it is primarily an African disease and an African problem. To explain how a disease originating in one continent was yet disseminated to the rest of the world from another, the scientists have argued that there was a remote central African "lost tribe" in whom the virus had been present for centuries,(3) or alternatively who acquired the infection from monkeys 30 or so years ago.(4) Haitians (but no-one else) working in central Africa then became infected (presumably heterosexually) and, on returning home, spread the disease to homosexual American tourists.(5,6,pp.17-20) By this circuitous route the virus reached the United States and from there spread to the rest of the world.

Because we suspected a racist motivation for the "science" that was arguing for AIDS from Africa we decided to review the scientific literature, eventually publishing our work in a book(7). When questioning the African hypothesis we anticipated a difficult task, as the research was conducted by reputable scientists and was subjected to peer review prior to publication. As our study progressed it became increasingly clear to us that the racist preconceptions of the researchers led them to conclusions that had no scientific foundation.

The Ideology of Racism

It is perhaps unwise to assume a consensus view of racism where none may exist, and for our purposes we would consider racism to be the ideology promoted initially by the Caribbean sugar-planters and slave-merchants to justify, sustain and defend their activities so important to the enrichment of Europe during the 17th and 18th centuries. The ideology was adapted and developed during the period of European colonisation during the 19th century and in the 20th century, reaching its apogee in the death camps of Nazi Germany. Unlike the variety of superstitious beliefs Europeans held of other peoples in previous centuries racism was relatively systematic and internally consistent, and with time acquired a pseudo-scientific veneer that glossed over its irrationalities and enabled it to claim intellectual respectability(8). Although the edifice of racism has begun to crack in the latter part of this century, racism remains integral to the European world view.

Many leading doctors and scientists of their day made their contributions to the pseudo-science of racism.(8,9) When humans were placed at the top of the evolutionary tree, Africans were allocated a separate species between other humans and apes and there were numerous suggestions that Africans had sexual intercourse with apes, or were the result of such unions. As Africans were deemed more akin to animals than humans, they were by definition incapable of civilised behaviour. They were believed to be sexually unrestrained and to have larger sexual organs than other races, and were therefore more prone to sexually transmitted diseases. They were deceitful, treacherous, lazy, faithless, cruel and bad-tempered. African skulls were studied and were considered to be smaller than those of Europeans, establishing beyond doubt that Africans had the lesser intelligence.(8) In one form or another, explicitly or implicitly, many of these notions have appeared in the scientific literature about AIDS and Africa.

Racism and "AIDS from Africa"

The first black people diagnosed as suffering from AIDS in any number were Haitians living in the United States.(10,11) The possibility that they may have caught the infection from Americans in the United States or in Haiti was not given serious consideration and Haiti was immediately accused of being the source of the epidemic.(11) Soon Haitians with AIDS were being reported from all over the Western world(12,13,14,15) and the Centers for Disease Control (CDC) in Atlanta, Georgia, included Haitians as a group at risk for AIDS along with homosexuals, intravenous drug users and haemophiliacs. It was only in 1985 that CDC, faced with overwhelming evidence that Haitians per se were no more at risk for AIDS than anyone else,(16) removed them from the high risk classification, but not before Haitians en masse were dismissed from their jobs, evicted from their homes, and even housed in separate prisons. Abandoning Haiti, the researchers then turned their attention to Africa.

One of the reasons given by scientists for this turn to Africa was the high incidence of Kaposi's sarcoma (KS) in Africa, although it was clear from the beginning that the benign clinical course of African KS was very different from the aggressive, disseminated form of KS in AIDS patients.(17) A number of AIDS-like cases were reported retrospectively, the most cited being a Danish surgeon who worked in Zaire and died in 1977.(18) This patient was given prominence in the best-selling book by Randy Shilt's "And The Band Played On" where, under "Dramatis Personae" she is listed as "Danish surgeon in Zaire, first westerner to have died of AIDS," and is described in the following manner:

"The battle between humans and disease was nowhere more bitterly fought than here in the fetid equatorial climate, where heat and humidity fuel the generation of new life forms... Here, on the frontiers of the world's harshest realities, Grethe Rask tended the sick(19)."

Jonathan Mann, former director of the AIDS program for the World Health Organisation (WHO) and medical text books are now citing the case as evidence that AIDS originated in central Africa.(20,21) It was claimed that she acquired the infection from her patients, at least one of whom had KS, but there was no firm evidence that she died of AIDS, and other diagnostic possibilities were not considered. In 1988, five years after the case was published, we learned that her serum had been tested and found human immunodeficiency virus (HIV) enzyme linked immunosorbent assay (ELISA) negative,(22) but the author of the original paper has not published this information in the scientific literature.

Although such AIDS-like cases are presented as evidence that the human immunodeficiency virus existed in Africa prior to the American epidemic, only African cases are considered and the many instances of AIDS-like cases documented in Europe and America are conveniently ignored.(23) Indeed, on the opposite page to the report of the Danish surgeon in the same issue of the Lancet was an account of an AIDS-like illness in a young German homosexual,(24) but whilst non-AIDS in a Danish surgeon heads the citation index proving an African origin, the German case has been completely ignored.

The next source of support for the African hypothesis came from the seroepidemiological studies undertaken in Africa or on African serum stored in the West. This research, more than any other, has been at the foundation of all the fantastic stories of millions dying in Africa. Using an enzyme linked immunosorbent assay seropositive figures of 25% of patients attending a clinic in rural Zaire in 1984,(25) 50% of the Turkanas in Kenya from 1980-1984,(26) and 66% of children in Uganda in 1972(27) were reported. As AIDS was rare or unknown in the areas where the serum was collected, one would expect the authors to have had serious doubts about the reliability of the tests, but sadly scientific scepticism has never been a feature of AIDS research in Africa.

One of the most cited studies was undertaken on serum collected in Zaire in 1959.(28) Using a number of tests in addition to ELISA, only one of 1,213 plasmas was positive, but the identity of the donor, described as "rural Bantu", was no longer known. As with the sporadic AIDS-like cases, only seroepidemiology in Africa is considered relevant to the question of the origin of HIV. A study using the same tests was undertaken on stored serum taken from "aboriginal" Amazonian Indians in Venezuela in 1968/69, and 9 of 224 samples were positive on all the tests.(29) The results were challenged by other researchers as probable false positivity,(30) but the single positive sample from Zaire continues to be cited as evidence that the world AIDS epidemic began in Zaire 35 years ago.

In an interview shown on British television Professor Hunsmann, head of virology and immunology section and professor of medicine at the (West) German Centre of Primate Research at Gottingen, discussed the problems of seroepidemiology:

"We had conducted quite extensive experiments in respect to the epidemiology... of the first human retro-virus... HTLV [Human T-Lymphotropic Virus]-I... For this reason we had several thousand serum samples frozen and saved in our refrigerated stock. When the news came that there was another, and new human retrovirus discovered, the AIDS virus... we could immediately search among our stock and probe for an earlier presence of this virus in Africa... These tests quickly and clearly gave results, namely, that the first "positive" probes which we could find among our more than 7,000 serum samples are dated only after the beginning of the 'eighties, from the years 1982-83; and that among samples from before that date -- and we had quite a lot of that earlier time in our stock- not a single one proved positive. We have concluded from all this that most other researchers had probably fallen victim to the technical difficulties connected with the conservation and analysis of older serum samples. And the American authors who originally had produced those high percentage data had to correct them -- but certainly, once some wrong information like that has been put into circulation it continues to go on. This has lead to quite a lot of friction between some African states and the United States."(31)

Later in the same interview when asked why AIDS is not considered to have originated in the United States, Professor Hunsmann made the following comment:

"Testing of the kind being done in Africa and to that volume has never been done by anyone in America. Nobody has looked at the stocked blood serum in the USA and there certainly is much more there than in Africa. Nor has anyone asked what happened to the general population. Only one single group, the homosexual community in San Francisco, has been analysed and the results showed a high percentage of HIV positivity already by the mid 1970's. But no other samples have been tested to the extent done in Africa. I think this should be clearly said."(31)

Why, then, if this research is valid (and there have not been any serious criticisms) have other AIDS researchers persisted in arguing that the African AIDS epidemic preceded the epidemic elsewhere in the world? And if the tests are unreliable, why are the predictions that millions of Africans will soon die from AIDS still presented without comment? How, indeed, is it possible that a virus could spread so much more rapidly by heterosexual contact in Africa than anywhere else in the world? It is here as in so many other aspects of AIDS research, that racist beliefs about the sexual propensities and promiscuity of Africans conflict with scientific evidence, and in such a confrontation belief is almost invariably the victor.

Researchers had originally proposed that AIDS was an "old disease of Africa" that had reached the West via recent intercontinental travel,(3) a rather curious notion given the enforced intercontinental travel of up to 100 million Africans in previous centuries(32). As this hypothesis become increasingly untenable attention was diverted to the possibility of a monkey origin of the virus. Such ideas cohabit easily with racist notions that Africans are evolutionary closer to sub-human primates. Dr. Robert Gallo and his co-workers were among the pioneers of this line of research, both for HTLV-I and HTLV-III (later renamed HIV).(5,33,34) Two of Gallo's colleagues, Kanki and Essex, reported the isolation of a virus similar to HTLV-III in macaque monkeys who were suffering from an AIDS-like illness, and labelled it simian T-lymphotropic virus type III (STLV-III) of macaques.(35) For those who were arguing an African origin of the AIDS virus, an Asian monkey like the macaque was not a suitable source, but less than six months later the same researchers reported finding the virus in "wild-caught" African green monkeys from Kenya and Ethiopia.(36) This research, like most other research on AIDS in Africa, was motivated only by a desire to prove an African origin of the disease, and was greeted with enthusiasm by the Western scientific community. Discussion quickly moved on to the question of how the virus crossed the species barrier, and two AIDS "experts" from St Mary's Hospital in London even offered this explanation:

"Monkeys are often hunted for food in Africa. It may be that a hunting accident of some sort, or an accident in preparation for cooking, brought people in contact with infected blood. Once caught, monkeys are often kept in huts for some time before they are eaten. Dead monkeys are sometimes used as toys by African children."(37)

Are we seriously to believe that African parents are so desperate for toys for their children that they give them putrefying carcasses of dead animals? More fantastic suggestions were published in The Lancet:

"Sir: The isolation from monkeys of retroviruses closely related to HIV strongly suggests a simian origin for this virus... Several unlikely hypotheses have been put forward... In his book on the sexual life of people of the Great Lakes area of Africa Kashamura writes: "pour stimuler intense, on leur inocule dans les cuisses, la region du pubis et le dos du sang preleve sur un singe, pour un homme, sur une guenon, pour ne femme" (to stimulate a man or a woman and induce them to intense sexual activity, monkey blood [for a man] or she-monkey blood [for a woman] was directly inoculated in the pubic area and also the thighs and back). These magic practices would therefore constitute an efficient experimental transmission model and could be responsible for the emergence of AIDS in man."(38)

This came in for particular derision at the conference on AIDS in Africa held in Naples in October 1987:

"When queried regarding the plausibility of a premise put forth in a letter to The Lancet suggesting that a bizarre tribal ritual of injecting monkey blood into the pubic region of young African men and women to stimulate intense sexual activity could be responsible for the emergence of AIDS in man, researchers from Zaire, Congo and Belgium were unanimous in declaring it to be preposterous..."(39)

It is hardly surprising that western AIDS researchers have become persona non grata in many African countries.

Most Africans, in fact, have little contact with monkeys,(40) and amongst those who regularly hunt monkeys, for example the pygmies of the equatorial rain forests, AIDS is notable for its absence.(41) On the other hand, in recent years there has been a marked increase in contact between man and monkeys not in Africa but in the West. In the 1920's the transplantation of monkey testes to humans was widely practiced, and many thousands of men in Europe, America and Australia received the benefit of this operation that promised to restore their youth and vigour.(42) Monkeys have been used widely for scientific research, and with the discovery that their kidneys provide excellent tissue culture material for virus isolation, propagation and vaccine production, hundreds of thousands have been caught and transported from their native haunts.(43) If there is any truth in the hypothesis that HIV originated in monkeys (and African monkeys are not the only candidates) it would seem more appropriate to investigate modern medical research than speculate about the customs and behaviour of Africans.

Although the African green monkey hypothesis was widely accepted, it came under increasing scientific challenge. Attempts to repeat the Essex and Kanki experiments on other wild African green monkeys were unsuccessful,(44) and the genetic sequences of the virus isolated from laboratory macaque monkeys, the virus Essex and Kanki claimed to have isolated from "wild-caught" green monkeys and another supposedly human virus called HTLV-IV, were found to be identical.(45) Essex and Kanki were then obliged to admit that their green monkey virus was a laboratory contaminant.(46) A retrovirus was eventually isolated from African green monkeys, but it bore little resemblance either to the macaque virus or the human AIDS viruses, and could not have originated from African green monkeys in recent times.(47,48) It is difficult to understand why this virus has been called simian immunodeficiency virus of African green monkeys (SIVagm) as it does not cause immune deficiency. In all this confusion of viruses one question surely needs to be asked: What is the origin of the virus that caused AIDS-like illnesses in laboratory macaque monkeys? This virus does not occur in wild macaque monkeys, but does have some similarity with the human AIDS viruses. Had these monkeys been subjected to experiments with retroviruses, and did the appearance of AIDS-like illnesses in the monkeys predate the human AIDS epidemic?

It is instructive for anyone who still has illusions in the objectivity of science or the integrity of some AIDS researchers to read the October 1988 edition of Scientific American. The issue was devoted to AIDS, and the section titled "The Origins of the AIDS Virus" was written by Essex and Kanki and was illustrated by a full page colour picture of an African green monkey. Eight months after admitting that the African green monkey virus was a laboratory contaminant, Essex and Kanki have the audacity to state:

"Why SIV is endemic in these wild African monkeys but seems to do them no harm, and is also found in the captive Asian macaques, where it causes disease, was (and still is) an enigma..."(49)

Does this re-presentation of discredited data signal the abandonment of any pretence of scientific integrity in order to promote conscious and deliberate propaganda?

Other attempts to implicate Africa in the AIDS epidemic also came to grief. Dr. Anthony Pinching and his team from St Mary's Hospital, London, claimed that a particular genetic variant, the Gc1f allele, predisposed the person to infection with HIV, and that this variant was common in central Africa.(50) The Gc1f allele had, in fact, been found to be common in the Bi Aka pygmies of the Central African Republic and the Peuhl Fula of Senegal, ethnically distinct groups in whom AIDS was either rare or notable for its absence,(41) but it would seem to European minds all Africans are the same. This research was reported in the media as a major breakthrough in the search for a cure for AIDS,(41) but a year later, after a number of other laboratories failed to confirm the findings, Dr Pinching admitted that their original data was erroneous.(51) At least Dr Pinching, unlike Dr Bygbjerg and so many other AIDS researchers, had the courtesy to admit his error publicly and apologise to his fellow scientists for the extra work he had caused, although his apologies were not extended to the many Africans whom he had offended.

Although many AIDS researchers now appreciate that they have offended and angered many black people. they remain ignorant of their unconscious racism and continue to give offence. The September 1988 edition of Medicine International was devoted to the subject of AIDS, and as usual there was an article on AIDS in Africa, but no similar discussion about AIDS in any other continent. The authors commented on the problems created by earlier AIDS research in Africa:

"Initial claims that the disease had been present in Africa for long enough for widespread immunity to have developed in exposed populations were false; epidemics of AIDS were as new in Africa as elsewhere. Considerable damage has been done to international research collaboration as a result of these claims."(52)

But later in the same article:

"The scale of African AIDS epidemic has led to speculation that heterosexual transmission is more efficient in Africa than elsewhere... social and cultural factors, such as the African tradition of male sexual freedom, may also play a part. The circulation of myths such as the only cure for AIDS being to have sex with a virgin is likely to have a greater effect on transmission in Africa than in developed countries."(52)

What do the authors of this paper know about African traditions of male sexual freedom, and does no such 'tradition' exist in the West? And on what evidence are we to believe that a significant number of African men are having sex with virgins to cure themselves of AIDS? But then if you already believe that Africans are more primitive and superstitious no evidence is required.

Other AIDS researchers have recognised that their past activities have caused problems. The British Medical Bulletin of January 1988, titled "AIDS and HIV infection: the wider perspective," was edited by three notable exponents of the African connection, Anthony Pinching, Robin Weiss and David Miller. They provide a classic example of muddled racist thinking:

"In the case of some early studies in Africa, techniques were used that had not been sufficiently well validated for African sera, given the prevalent hypergammaglobulinaemia and a notorious tendency to "stickiness" and false positive reactions in antiglobulin assays. The observations derived from these studies have led to some confusion and have also tended to damage the credibility of foreign scientists working in Africa -- especially among local leaders."(53)

Who was confused by this bad science? Certainly not Africans, whether ordinary citizens or "local leaders". The racist themes were all too familiar, the response was anger and not confusion, and the discrediting of the science came as no surprise, as it was never believed in the first place. The AIDS experts continue:

"Additional problems have been created when investigators have spent a short time collecting sera and basic data in a developing country, often with little guidance from local investigators, and then published the data without reference to the original context. This has tended to produce scientific data that has not been adequately placed in an anthropological perspective." (53)

In other words data collection was biased or inadequate, and this led to a misinterpretation of results. The racism responsible for this is charmingly described as an inadequate "anthropological perspective!" But worse is to come:

"Even worse, it has led to denial and resentment, jeopardising essential and potentially fruitful collaboration between investigators in the developed and developing world in a study of an issue of mutual concern. This has been particularly damaging when the pursuit has apparently been the origin of AIDS and HIV, an essentially academic question, however interesting. Such investigations have often been taken to imply blame on the region that appears to be the source. Although they were certainly never intended to impugn any community in this way, it is not difficult to see how such perceptions arose."(53)

Recognition that the faulty techniques described at the beginning of the paragraph provided the "evidence" for an African origin for HIV is beyond the wit of these clever scientists, who then accuse Africans of "denial and resentment" when they refuse to accept their findings! Let us gratefully accept their condolences for the injuries they have inflicted, and put aside our resentments, so that we can leave ourselves open to more of the same, to be found later in the Bulletin:

"HIV infection appears to have spread over much of the world during the decade 1976-1986, mirroring on a large scale the spread of its most obvious predecessor, syphilis, in Europe in the 1490's. As with early syphilis, the international spread of AIDS has led to a process of attribution and denial about the origin of the disease. However, it seems most likely that HIV spread to the United States from Africa, perhaps via Haiti, in the mid 1970's and from the United States to many western countries in the late 1070's and early 1980's."(54)

Others are not so confident, at least when they address Africans at AIDS and Africa conferences:

"Luc Montaigner, the first scientist to isolate the virus that causes AIDS, agrees that if an isolated population in Africa existed as a reservoir for the virus, researchers would have found it by now. The data suggesting that the virus comes from Africa are weak, Montaigner said. "Maybe we should look to another part of the world."(55)

Jonathan Mann, then the director of WHO's AIDS programme, also felt obliged to distance himself from an African origin:

"The World Health Organisation's position is that there is not yet enough information about the origin of the virus. There are absolutely no data to support any hypothesis... "The more information that emerges, the less we know about where this virus came from, how long it has been in the world, and how it grew to become the problem that it is today," he said. The syndrome has too often unveiled thinly disguised prejudices about race, religion, sex, social class, and nationality, and the Africans properly resent that Africa has been singled out, Dr Mann said. If San Francisco was accused of being the original source of HIV with no more proof than there is that Africa is the source, special interest groups would be up in arms, he said... Dr Mann said that nothing will keep people from coming up with "cheap hypotheses" about the origin of AIDS. "They die a natural death when no subsequent evidence develops to take then seriously. But journals should have a special page for them labelled 'fuzzy ideas', he said. "The real danger is that future authors might use such discredited, but published, hypotheses as scientific references for future articles", he said."(39)

This would seem a classic case of white man speaking with forked tongue, as there is a qualitative difference between racism and mere "fuzzy ideas", and whilst the publication of "fuzzy ideas" may be no more than a reflection on the quality of the journal, racism should find no place in its pages. The director of the WHO's AIDS program and his associates were in a position to request that the medical and scientific journals adopt and implement anti-racist policies. Instead they were content to show their bleeding hearts only at conferences attended by Africans.

Although racism can be found in abundance in the medical literature about AIDS and Africa, Two psychologists, J. Phillipe Rushton and Anthony F. Bogaert, have drawn together these ideas and have attempted to give them a pseudo-scientific coherence. According to the British newspaper the Independent on Sunday, Rushton has received funding from a racist American trust and was investigated by the Canadian police under the hate propaganda laws. Rushton and Bogaert's paper, titled "Population differences in susceptibility to AIDS: an evolutionary analysis", was published in a leading British journal, social Science and Medicine. The abstract is as follows:

"Previously we have reported population differences in sexual restraint such that, higher socio-economic status > lower socio-economic status, and Mongoloids > Caucasoids > Negroids. This ordering was predicted from a gene-based evolutionary theory of r/R reproductive strategies in which a trade-off occurs between gamete production and social behaviours such as intelligence, law abidingness, and parental care. Here we consider the implications of these analyses for sexual dysfunction, including susceptibility to AIDS. We conclude that relative to Caucasians, populations of Asian ancestry are inclined to a greater frequency of inhibitory disorders such as low sexual excitement and premature ejaculation and to a lower frequency of sexually transmitted diseases including AIDS, while populations of African ancestry are inclined to a greater frequency of uninhibited disorders such as rape and unintended pregnancy and to more sexually transmitted diseases including AIDS."(56)

It is not possible to discuss this article in detail, but the only difference in substance from the pseudo-scientific racism of previous centuries is the different ranking order of the races. Mongoloids are now superior to Caucasoids, although Negroids, of course, remain at the bottom. Meaningless algebraic presentations such as r/K only give a modern veneer to very old ideas. We are told, for example, that the average cranial capacity of Mongoloids is 1,448 cm3 v 1,334 cm3 for Negroids whilst genitalia and secondary sex characteristics of Mongoloids are, of course, small and that of Negroids large, and for such reasons AIDS is rampaging through Africa. It is difficult to believe that such an article would be published anywhere but in a right-wing fringe magazine, but after a decade of AIDS pseudo-science anything seems possible.

The AIDS establishment has typically responded to the charge of racism with the counter-accusation that such criticism deny an African AIDS epidemic, giving African governments an excuse not to take measures to contain the epidemic. In fact we do not deny the existence of an AIDS epidemic in Africa and elsewhere in the world, but believe the scale of the epidemic is open to question. Whilst doctors from the West claim there are tens of thousands of Africans dying from AIDS, and that millions are already infected with HIV, the experience of African doctors and ordinary people is very different. One Zimbabwean woman who in 1988 had not seen or heard of anyone with AIDS said that it was like being asked to believe in the Holy Ghost.(57) A Ghanaian physician, Dr. Konotey-Ahulu described the AIDS epidemic in the following way:

"...The African does not speak of Africa as if it was 'a little country somewhere in Timbuktu'. Africa is a massive continent with 600 million people in 2,300 tribes distributed in 53 different, sometimes very different, countries. For example, the difference between Ghana and next-door Ivory Coast vis a vis the sex trade is the difference between Ghana's ex-colonial master Britain and Cote d'Ivoire's France. Scientific and media descriptions of Africa's 'AIDS elephant', with its 53 body parts, have sometimes been like those of the proverbial blind men surveying the elephant. Most researchers concentrate on the tusk and, not surprisingly, come out with 'the AIDS problem in Africa is very sharp and pointed; the whole continent is like that'. Even when experts from Nigeria, the large body-part of the elephant, confirm with seropositivity studies that there is not yet an AIDS problem in their country, they are shouted down with "Under-reporting! Under-reporting! The whole beast has a sharp profile." To these safari experts, Tanzania and Sierra Leone, Uganda and Gabon, Zaire and Ghana, Rwanda and Gambia, are all the same..."(58)

Dr Konotey-Ahulu toured all the AIDS affected African countries (except Zaire, where he was refused entry, although US government sponsored AIDS researchers appear to have no such difficulties) and reported his findings in the British Medical Journal and the Lancet:

"In February and March of this year [1987] I made a six-week tour of twenty-six cities and towns in sixteen sub-Saharan countries, including those most afflicted by AIDS, did ward rounds with doctors and nurses, met ministers of health, directors of medical services, and research workers (native and expatriate)...

"If one judges the extent of AIDS in Africa on an arbitrary scale from grade I (not much of a problem) to grade V (a catastrophe), in my assessment AIDS is a problem (grade II) in only five, (possibly six, since I was unable to obtain a visa for Zaire) of the countries where AIDS has occurred... In no country is the AIDS problem consistently grade III (a great problem), or ever grade IV (and extremely great problem), and in none can it be called a catastrophe (grade V). In Kenya, for instance, contrary to widespread reports I would rate AIDS in 1987 as grade 1...

"Before the days of AIDS in Ghana there was a death a day... on my ward alone of thirty-four beds... They died from one or another of the following: cerebrovascular accident from malignant hypertension, hepatoma, ruptured amoebic abcess, haematemesis, chronic renal failure, sickle-cell crisis, septicaemia, perforated typhoid gut, hepatic coma, haemoptysis from tuberculosis, brain tumour, Hodgkin's disease... Today, because of AIDS, if seems that Africans are not allowed to die from these conditions any longer. If tens of thousands are dying from AIDS (and Africans do not cremate their dead) where are the graves?...

"Why do the world's media appear to have conspired with some scientists to become so gratuitously extravagant with the untruth?"- that was the question uppermost in the minds of intelligent Africans and Europeans I met on my tour."(59)

Dr Konotey-Ahulu was particularly critical of Western researchers who, with no experience of tropical medicine, used seroepidemiology as a substitute for, rather than an adjunct to clinical epidemiology, and described the difficulties faced by doctors working in Africa who sought funding from external research agencies to increase their clinical epidemiological research base.(60)

Although African governments have repeatedly been accused of under-reporting and the number of AIDS cases notified to the World Health Organisation from African countries have never reached the expectations of the Western AIDS establishment,(53) it is important to appreciate how even these relatively modest figures are derived. In the West AIDS is diagnosed and hence reported when a patient develops an opportunistic infection or AIDS dementia.(61) The diagnosis is confirmed with at least two and often more different types of tests, e.g. ELISA, Western blot, radioimmunoprecipitation assay. Thus the great majority of patients with symptoms and signs of HIV infection, i.e. those with persistent generalised lymphadenopathy or AIDS related complex (now called symptomatic HIV infection) do not reach the official statistics until they develop opportunistic infections or dementia. There is a degree of under-reporting (up to 20 percent in the United States) but virtually no over-reporting.(62) Because of the expense of laboratory tests for HIV infection and opportunistic diseases physicians and health workers in most African states have been encouraged to use the WHO clinical criteria for AIDS, confirmed with ELISA when available.(63) The WHO clinical criteria do not distinguish AIDS and symptomatic HIV infection, and in Africa both are therefore reported as AIDS cases.(64) Nor do they differentiate AIDS from other clinically similar wasting diseases and a number of studies have shown that between 26 and 50 percent of patients who fulfil clinical criteria are seronegative for HIV infection.(65,66,67)

Diagnostic pitfalls include infections particularly tuberculosis, parasitic infestations, lymphomas and occult carcinomas, and endocrine disorders such as diabetes mellitis, thyrotoxicosis and Addison's disease.(64,68) Confirmatory testing with ELISA, if available, also presents difficulties, given the high rate of false positivity with this test. In this context it is curious to note that the proportion of African AIDS patients who have died is much lower than that in the West, where it is consistently 50 to 60 percent.(64,65) It is most unlikely that Africans with AIDS live longer than their Western counterparts, and far more probable that reported African cases include patients at an early stage of the disease and patients with clinically similar but less deadly diseases.

If the criteria used to diagnose AIDS in Africa were used in the West the number of Western AIDS cases would increase manifold, and therefore comparisons between the incidence of AIDS in Africa and the West are meaningless. Such difficulties are usually dismissed on the assumption of enormous under-reporting of AIDS in Africa, but if this were so, what happens to these patients? Do they die, or do they somehow fade away unmourned, unburied and unrecorded. In Africa as in the West AIDS is predominantly afflicting the young, sexually active section of the population and a change in the pattern of disease and death in this group would be reflected in official statistics even if not reported as due to AIDS. This has been demonstrated in Britain where there has been an increase in the death rate amongst young men, and up to 500 may have died of AIDS in the last year without being reported as such.

Yet Western researchers seem incapable of believing that African countries gather such statistical information although it is often readily available in the libraries of their own institutions. When comparing the incidence of AIDS in different countries it is also important to consider the rate of progression from HIV infection to 'full blown' AIDS. It is probable this will be more rapid in countries with a high rate of infectious and parasitic disease, and consequently the proportion of AIDS patients to the number with HIV infection will be higher. Even if African states were using the same criteria to diagnose AIDS as in the West, assumptions about the prevalence of HIV infection based on Western experience would be misleading.

Even if one chooses to ignore the information provided by various African Ministries of Health some assessment of the scale of the African epidemic can be made by studying expatriate Africans. Many Africans in Europe and America are temporary residents, or travel home frequently, and AIDS in this group should mirror the epidemic in their countries of origin. Whilst there was much excitement about the incidence of AIDS in expatriate Africans in Europe in the early 1980's,(69,70,71) the number of Africans diagnosed in Europe actually declined between 1984 and 1986,(72) perhaps because reliable tests for AIDS became available, and only in 1987 showed a modest increase. Africans with AIDS in Europe are no longer reported separately by the WHO,(73) perhaps because they have ceased to be a significant proportion of the total European cases. Although there was much talk of the risks of transmission of HIV-2 by West Africans in Britain, more than 6,500 patients with West African connections were tested and all were found negative for this virus.(74,75) It is curious that expatriate Africans in the United States have never featured in discussions about the supposed African origin of AIDS, nor have they been reported as suffering from AIDS in any number.

Sound scientific methodology surely dictates that evidence contrary to a proposed hypothesis should be sought as vigorously as evidence for the hypothesis. In the case of AIDS from Africa contrary evidence has not been sought at all, but this singular deficiency in effort is then presented as a lack of result. If scientists did wish to explore the possibility that HIV was introduced to Africa from the United States and Europe we would mention two possible areas for research. The first is the export of infected American blood products. Discussion in the scientific literature about Africa and transmission of HIV by blood products inevitably concentrated on the possible importation of infected plasma to America from Africa (an unsubstantiated hypothesis that died quickly),(76) or the spread of HIV in Africa by local blood transfusions.(77) We could find only one reference to the export of infected American blood to third world countries, in a WHO working paper where it was said that contaminated plasma pools may have been sold at discount prices in developing countries since they could not check the products.(78) Western countries outside the USA are for the most part self sufficient in whole blood and plasma, and the only significant group infected from America were haemophiliacs who were given imported American clotting factors. Poor countries often cannot afford a blood transfusion service, and wealthy patients with blood loss may be transfused with imported blood whilst the poor at best receive an immediate transfusion from a relative or friend. If imported whole blood was responsible for introducing AIDS into Africa, this would be consistent with the initial appearance of AIDS in the urban-based elite in countries like Zaire which are particularly dependant on America. It would also account for the development of AIDS in expatriate Europeans, such as the French woman who developed AIDS after a blood transfusion in the Cameroons, as it is unlikely that she was transfused with locally obtained blood.(79)

A second, and we suspect far more important route by which AIDS may have been introduced into Africa is sex tourism. AIDS researchers, who seem unable to contemplate that white men can infect African women, have presented AIDS in Africa as a disease transmitted by promiscuous men (and to racist minds all Africans are promiscuous) to prostitutes who then infect foreign clients.(80) Prostitution in African countries tends to occur at two levels: with younger and prettier women seeking valuable foreign exchange who work in the large hotels and night spots which attract foreign tourists and wealthy Africans, and with older and less attractive women whose clientele is predominantly poor and local. If African realities agreed with the researchers suppositions, older African women and their local clientele would be bearing the brunt of the epidemic, but to the contrary it is the young women frequenting the tourist centres and foreign military and naval establishments who are developing AIDS and are transmitting it to their African sexual partners: husbands, boyfriends and wealthy African clients.(58,81)

Conclusion

When discussing the issue of the origin of AIDS we are frequently asked by well meaning people "Does it really matter where AIDS came from, shouldn't we forget about the origin and concentrate on dealing with the epidemic". Certainly we agree that every effort should be made to contain the epidemic, in Africa as elsewhere in the world, but AIDS researchers have opened a Pandora's box of racism and prejudice that cannot be closed by simply dropping the subject of the origin. Incorrect assumptions about the source and nature of the African AIDS epidemic will also inevitably lead to inappropriate programs for containment and control. Africans have complained that scarce resources from the WHO have been diverted from programs to control major epidemic diseases that are killing many more people than AIDS, and insufficient emphasis has been placed on the risks of sex for money whilst the dangers of low levels of promiscuity have been exaggerated to such an extent that people have even committed suicide because they feared they had AIDS.

Although racism in its various manifestations has come under increasing challenge in recent years it remains a potent influence, and it is naive to believe that medical science is immune to this particular poison. With the emergence of a new and deadly sexually transmitted disease it was perhaps almost inevitable that Black people would be attributed with its origin and transmission, whatever the evidence. Racism is an irrational system of beliefs without scientific foundation, and much of the confused, contradictory and simply nonsensical conclusions reached by the scientists about AIDS and Africa can be attributed to their attempts to square their research findings with their racist preconceptions, rather than objective scientific reality. The determined pursuit of the African origin has been of little scientific or practical merit, but instead has escalated racism, created conflict between African and Western countries, diverted resources away from areas where they are much needed, and has wasted time. Let us hope we can learn from our mistakes, otherwise we will be doomed to repeat them. *

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Source: Chapter 12 of "AIDS in Africa and the Caribbean" edited by: Professor George C. Bond, professor of anthropology and director of the Institute of African Studies, Columbia University, John Krensike, associate professor of anthropology ar Hofstra University, Ida Susser, professor of anthropology at Hunter College, City University of New York, Joan Vincent, professor of anthropology at Barnard College, Columbia University. Published by Westview Press, 1997. ISBN 0-8133-2878-0.