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THE
CRIME OF ASKING QUESTIONS AT AN AIDS PANEL DISCUSSION
By David Crowe
April 2,
2003
I almost got arrested for the first time in my life a few
nights ago. My crime? Asking questions and pointing out
speakers’ errors at a panel discussion organized by the
University of Calgary Global AIDS Action Group (GAAG).
It certainly isn’t very Canadian to be so forward. I
should have waited until question time, and then asked one
question, maybe two, but only after complimenting the speakers
for their erudition. But, I did not come to the panel
discussion to be a polite Canadian. I suspected that the
panelists would all fall over themselves agreeing with each
other, and all would repeat dogmatic assertions about HIV and
AIDS without contradiction from within or outside of the
panel. The student moderators would be unfailingly polite and
respectful, and everyone would go away believing that they
could play a small part in mitigating an enormous medical
tragedy. Well, I was right, except that possibly some members
of the audience did actually leave with some nagging questions
about HIV/AIDS.
I very much appreciated the irony of using tactics of civil
disobedience against a group which probably would
enthusiastically support the use of similar tactics against
the military, multinational corporations and against
government suppression of dissent Yet, these same people
unquestioningly support a model of disease that makes billions
of dollars in profits for multinationals.
May aim was not to interact with the panel or the
moderators, to persuade them that there were holes in their
knowledge, or flaws in their base of factoids. I only
challenged them as a way to expose the audience to some
alternative views. Hopefully by challenging the panelists with
science-based evidence, I thought I could make the audience
see that there was another side. I had no power or desire to
impose my views, but I was not going to allow the one-sided
affair to proceed as planned.
I allowed the first speaker, Le Ann Dolan of AIDS
Calgary, the local HIV/AIDS service organization to speak
for about five minutes about the burgeoning AIDS epidemic in
Canada before interjecting my first question. "How many
new AIDS cases were there in Canada last year?" She
stopped, looked puzzled, and did not answer. I asked this
question because I knew that the audience would be shocked to
find out that there were only 221 new cases of AIDS diagnosed
in 2001 (2002 figures are not available yet). And, that is no
anomaly, the case count has declined every year from a peak of
1,759 in 1993 [LCDC, 2002] Now it is true that Health Canada
will probably manage to double the number of 2001 cases by the
next report, as they do most years, although they have never
explained to me how their surveillance system can be so lousy
that it takes over a year to report most cases (and I have
asked). But even 450 cases in one year is probably far fewer
than most in the audience would have guessed. The rarity with
which the easily available annual case figures are reported in
the media and at talks like this illustrates the power of
misinformation by omission.
Le Ann continued for a while, emphasizing the danger of HIV
to Canadian women and aboriginals and claimed, at least for
women, that female cases were rising. This is an oft-repeated
falsehood, encouraged by government reports that emphasize the
percentage of total cases, not the actual number. The
percentage of cases among women has admittedly risen from 7%
in 1992 to 19% in 2001, but far more importantly, the total
number of female cases has declined from a peak of 138 in 1994
to only 34 new cases in 2001. [LCDC, 2002]
Even in the annual Health Canada surveillance report,
tricks with percentages are still used. Figures graph the
percentage of cases in a number of categories, without
reference to the actual number. The graphs give the impression
of increasing epidemics in some categories with decreases in
others. But, because the percentages always add to 100%,
obviously you cannot have declines without exactly offsetting
increases. This supports the categorization of a still flaring
epidemic, unlike the actual number of cases, which are
declining to ever more trivial numbers in all categories.
It would be interesting to compare the total number of new
AIDS cases among women every year against the number of AIDS
service organizations for this group. I suspect that the
number of organizations long surpassed one per new annual
victim.
At this point Sarah Stewart, the student organizer came
over to me, shook my hand, looked me in the eye and with
studied calmness addressed me by my name, asking me to stop
interrupting the meeting. I was a bit surprised to hear myself
say that I had no plans to do that, but if the speakers made
errors I would continue to ask questions or make comments to
combat the misinformation that was being spread.
Sarah returned to the other side of the room and had a
hurried tęte ŕ tęte with one of the other panelists,
Dr. Don Ray, who was soon on the phone. I knew full well what
he was doing. Shortly after, I turned around to verify that
campus security had been called, and was a bit surprised to
see two uniformed police officers standing in the back of the
room.
Louise Lambert of the Women’s Working Group on AIDS was
now speaking about vaginal microbicides. I was trying hard to
find something to disagree with, but she carefully went
through a content-free presentation (I exaggerate, but only a
bit). She did not mention any microbicides by name. I was
hoping that she would mention Nonoxynol-9, because that one
has been an utter failure. [Kreiss, 1992; Van Damme, 2002;
Wilkinson, 2002] She did not report any successes (which I
believe is correct). She did not promise anything really,
except that more research might result in a vaginal
microbicide that works against HIV and AIDS. Her main point
seemed to be that if this technology could ever be made safe
and effective, it would give women more control over the
method of protection from HIV.
Unlike the speaker from AIDS Calgary, Lambert
provided no specifics for me to push back against, so I
remained quiet. Perhaps because of this, or perhaps because
the next speaker announced that his presentation would be a
slide show of his recent trip to Africa, the policemen left
the room.
Dr. Ray’s slides illustrated how grass-roots
organizations of women in Ghana are looking after the
so-called AIDS orphans. There was not much to criticize here,
as any initiative to care for orphans is something that would
be hard to argue against, and Dr. Ray did not provide any
specifics on how it was determined that the parents had AIDS.
I did later describe the World Health Organization’s
‘Bangui’ definition of AIDS [WER, 1986] which is still
used (with minor variations) to diagnose AIDS in Africa. No
HIV test is required (and no HIV test is usually performed).
All that is required is 3 of the following 4 symptoms:
persistent cough, persistent fever, persistent diarrhoea and
weight loss (greater than 10% of total body weight). A
definition that stands in stark contrast with the US
definition which allows the diagnosis of AIDS with no illness,
just a low CD4 immune cell count (in almost 2/3 of cases
according to the last published statistics) in combination
with a positive HIV test. [CDC, 1998]
Finally, the three presentations were over, and it was
question time. I assumed that now I could ask questions
without fear of imprisonment. The moderator did her best to
ensure that I didn’t dominate the question period, looking
desperately around the room for a raised hand from anyone but
myself. Luckily for me, and unluckily for her, other questions
were sparse.
I challenged Dr. Ray on his statement that clean needle
programs are known to decrease rates of HIV infection. A study
from Montreal, for example, shows spectacularly the opposite
— exclusive clean needle users were 10-22 times more likely
(depending on how the numbers were adjusted) to be
HIV-positive than those that never used clean needle exchanges
[Bruneau, 1997]. Those who sometimes or usually used the
exchanges had intermediate levels of risk. I noted that
similar, although not as dramatic results were found in
Vancouver [Strathdee, 1997] and in Seattle against HIV,
Hepatitis B and C [Hagan, 1999]. A female student from the
audience challenged me on this, asking how IV drug addicts
could be trusted to give accurate information. That was quite
perceptive, although it is hard to see how normal lying could
lead to these results. The majority of addicts would have had
to give answers that were the opposite of the truth, in order
to explain these results, which seems quite unlikely. The
student would have done better to challenge me on whether the
Seattle study really included an HIV arm. It did not; it only
studied Hepatitis B and C.
I was challenged by the audience on a number of statements
that I made. A few just felt that I was being rude
interrupting the meeting, but some, such as on the issue of
needle exchanges, wanted to challenge my data. One male
student scoffed at my claim that there have been no studies
that have shown adverse health outcomes from breastfeeding by
HIV-positive mothers. "So what", he claimed,
"better to be safe than sorry". A statement that
shows such tremendous ignorance of the millions of children
around the world who die from the adverse effects of formula
(or alternatively, the billions of people around the world who
are alive because they were breastfed) that it left me
speechless for a moment.
The most important argument that I put forward in the
context of this meeting was the challenge to the belief that
HIV in Africa is heterosexually transmitted. Four papers
recently published in the International Journal of STDs and
AIDS (Brewer, 2002; Gisselquist, 2002; Gisselquist, 2003a;
Gisselquist, 2003b) challenge this notion, estimating that
instead of explaining 90% of HIV transmissions, heterosexual
intercourse only explains 25%-29% of cases. The authors argue
that most of the rest are caused by unsafe medical injections.
This is so critical because the panel basically supported a
feminist model of AIDS, with women being the victim of sexual
aggression by men, with HIV being transmitted as a side
effect. Dolan related the story of an HIV-positive man whose
wife had died of AIDS, who felt that he had a right to a woman
to satisfy his needs, regardless of the fact that his HIV
might kill her too.
The AIDS Calgary representative implied that women
were being harder hit in Canada than men, something that is
still patently false (although not as false as the statement
would have been a decade ago). The 34 female cases of AIDS in
2001 are still significantly outnumbered by the 183 male
cases. Louise Lambert from the Women's Working Group on
AIDS focused on vaginal microbicides as a way to allow
women to protect themselves against HIV in a culture where men
are often unwilling to use condoms. She only vaguely hinted at
the possibility that these chemicals might prove to be not
only ineffective, but also toxic. The only man on the panel,
Dr. Don Ray, a professor of political science, documented the
empowerment of women in Ghana.
This feminist argument relies on heterosexual intercourse
being the main means of transmission of HIV. Without this, the
connection between sexual power politics and AIDS falls apart.
The argument has two other weaknesses as well. It portrays men
as incapable of love and fidelity, stereotyping them as
interested only in satisfying their own lust, with no concern
for women. Women on the other hand, are portrayed as sexually
passive, as incapable of being sexually irresponsible or
adventurous as men are of being responsible. Ultimately, it is
a very Victorian view of both genders.
But a larger problem is the unspoken, racist, dark side to
this view. If all men were like this, then AIDS should be
evenly distributed around the world, not just in Africa.
Consequently, a corollary of this argument is that it is
largely black men who are insatiable sexual predators.
The meeting organizer, Sarah Stewart, challenged me when I
mentioned these recent papers on heterosexual transmission.
She had, she noted, recently talked to a professor, who had
read one of the papers, and concluded that the authors were
not really saying that heterosexual transmission was not the
major cause of HIV transmission, just that its impact had been
over-emphasized. Obviously, the professor had not read the
papers.
Acceptance of third or fourth hand information, is a form
of intellectual laziness that allows the widespread acceptance
of current dogmas about HIV and AIDS. It was clear that only
one member of the panel (Dr. Ray) had even a passing
acquaintance with scientific literature on HIV and AIDS. Yet,
the panelists, the organizers and some members of the audience
had no trouble staunchly defending their beliefs, while being
equally unable to produce any verifiable evidence.
This meeting illustrated to me how the AIDS dogma is
reinforced at the very lowest levels of the scientific
hierarchy. By repeating the same information over and over
again, without fear of contradiction, meetings such as this
one reinforce through repetition. Information flows through
the system like a waterfall, always in one direction, and
without barriers.
People who attend these meetings do care about the world,
probably much more than average. Consequently, beliefs about
AIDS have to be wrapped in a rhetoric that will appeal to
them. The story that people are dying in Africa because men
are irresponsible, and women need to be more empowered, is an
attractive idea. None of these people would have likely
attended if the panel spoke directly of how black men are
sexually irresponsible. Yet, this is the racism underlying the
feminist sugar-coating.
The people attending would all probably have labeled
themselves as curious, thinking, scientific and skeptical. Yet
there appeared to be a deliberate avoidance by panel members,
organizers and the audience of the tough job of actually
reading scientific papers, discussing them with others,
reading commentaries on them, comparing opposite viewpoints,
and most importantly making up their own minds.
Further Reading
[Brewer, 2003] Brewer DD et al.
Mounting anomalies in the epidemiology of HIV in Africa: cry
the beloved paradigm. Int J STD AIDS. 2003; 14: 144-7.
[Bruneau, 1997] Bruneau J et al.
High Rates of HIV Infection among Injection Drug Users
Participating in Needle Exchange Programs in Montreal: Results
of a Cohort Study. Am J Epidemiol. 1997; 146(12): 994-1002.
[CDC, 1998] HIV/AIDS Surveillance
Report (through December 1997). CDC. 1998; 9(2).
[Gisselquist, 2002] Gisselquist D
et al. HIV infections in sub-Saharan Africa not explained by
sexual or vertical transmission. Int J STD AIDS. 2002 Oct;
13(10): 657-66.
[Gisselquist, 2003a] Gisselquist D
et al. Let it be sexual: how health care transmission of AIDS
in Africa was ignored. Int J STD AIDS. 2003; 14: 148-161.
[Gisselquist, 2003b] Gisselquist D
et al. Heterosexual transmission of HIV in Africa: an empiric
estimate. Int J STD AIDS. 2003; 14: 162-73.
[Kreiss, 1992] Kreiss J et al.
Efficacy of nonoxynol 9 contraceptive sponge use in preventing
heterosexual acquisition of HIV in Nairobi prostitutes. JAMA.
1992 Jul 22/29; 268(4): 477-82.
[LCDC, 2002] Laboratory Centre for
Disease Control. HIV and AIDS in Canada: Surveillance Report
to December 31, 2001. Health Canada. 2002 Apr.
[Strathdee, 1997] Strathdee SA et
al. Needle exchange is not enough: lessons from the Vancouver
injecting drug use study. AIDS. 1997 Jul 11; 11(8): F60-5.
[Van Damme, 2002] Van Damme L et
al. Effectiveness of COL-1492, a nonoxynol-9 vaginal gel, on
HIV-1 transmission in female sex workers: a randomised
controlled trial. Lancet. 2002 Sep 28; 360: 9338.
[WER, 1986] WHO/CDC case
definition for AIDS. WER. 1986 Mar 7; 61(10): 69-76.
[Wilkinson, 2002] Wilkinson D et
al. Nonoxynol-9 spermicide for prevention of vaginally
acquired HIV and other sexually transmitted infections:
systematic review and meta-analysis of randomised controlled
trials including more than 5000 women. Lancet Infect Dis. 2002
Oct; 2(10): 613.
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