Appropos of the global AIDS (non) pandemic issue, it seems worth asking this question. Which would you rather believe on AIDS, the New York Times or the Rolling Stone?
The AIDS reporters at the Times are headed by Lawrence Altman, who has consistently hewed to the party line with rare exceptions where he actually notes some of the smaller anomalies of mainstream AIDS thinking.
Perhaps this is because he was trained at the CDC, and is therefore unlikely to contradict that institution too often, despite its atrocious performance on AIDS and AIDS statistics, which mathematician Serge Lang of Yale has trashed so thoroughly in his book Challenges (Springer-Verlag New York 1998) and in Lang Files, mailed around the country to key journalists including Altman.
Rolling Stone on the other hand achieved the following remarkable report in 2001, which states that AIDS in South Africa (then said by UNAIDS to be running at 17 million Africans dead of AIDS and 25 million more with HIV, with one in four South African adults infected) was a no show. Couldn’t be found. Didn’t seem to exist. No AIDS epidemic.
What? Yes, Rian Molan, a South African novelist of some repute, was asked by Jan Wenner of Rolling Stone to do a nice report on AIDS in South Africa in all its gory glory, and apparently was promised enough ready money and expenses to set out with great confidence and enthusiasm to do same. But almost immediately he ran into a problem: where were all the AIDS patients? According to everybody’s belief and the news media reports domestic and international. there should have been so many of them the sick should have been littering the sidewalks of Capetown and the Soweto shantytowns and kraals of that fair country (the climate is roughly equivalent to European countries of the same latitude).
But nada. Ryan couldn’t find the epidemic. Yes, there were plenty of patients sick and dying but no more than there had ever been, as far as he could find. Even the coffin makers were complaining. Where was all the booming business they had been led to expect?
Molan emailed Wenner to this effect and was told not to worry, the AIDS epidemic was surely there, just keep going. So he did. To no avail. Finally, he had the bright idea of going to check the death statistics of South Africa. Well, what d’ya know? They hadn’t budged by any significant amount that didn’t reflect the burgeoning population growth that South Africa in common with the rest of the sub-Sahara has enjoyed for the past quarter century.
In other words, no bulge. So, no discernible AIDS epidemic. And no payment to Molan, it looked like. But Wenner said, Well, write the story anyway. and he did. And this is it below, if you care to read it. But don’t tell anyone you read it, at least not before finding out whether they are a fully paid up member of the AIDS orthodoxy. For in general, such corrective heresy does not go down too well with HIV supporters.
As indeed Rian Molan’s wife clearly appreciated. As Molan later told it, she stood behind him with a rolling pin as he typed threatening to whack him over the noggin if he continued to write such subversive thoughts.
Here are a few sample paragraphs to whet the appetite of those readers who find reading more than a hundred words at a time on the Web daunting. Let us say one thing, though: Rian’s article is the best quick survey of the problems with the “global AIDS pandemic” available anywhere. You’ll see exactly why, among other things, HIV testing in Africa is a farce.
Note that Molan, even though he implies Thabo Mbeki may be on the right track in his suspicions, never quite gets to the stage of accepting or even imagining that HIV might not cause anything at all, and the whole puzzle easily resolved by simply throwing out this problematical paradigm, and instead of what may be a vast process of reinterpreting all these other sources of human sickness and death such as malaria and TB, and calling them AIDS, simply recognize them for what they are: Not AIDS but TB, Not AIDS but malaria, etc.
In other words, you don’t have to be an “HIV denialist” to see that the whole African pandemic is a crock. But you do lack an answer as to what the heck is going on.
Here is the whole classic tale, which essentially went nowhere in terms of rocking the HIV=AIDS boat, possibly because Jan Wenner runs into Mathilde Krim too often on the dinner party circuit in Manhattan.:
eprinted from RollingStone Magazine, November 22, 2001
AIDS in Africa: In Search of the Truth
By Rian Malan
“The frightening numbers were all that mattered. Once they were shown
to be accurate, further debate would be rendered obscene. So I set
out to confirm the death toll. I thought it would be easy—my first
mistake…â€Â
===
1. MY FIRST MISTAKE
Africa’s era of mega death dawned in the fall of 1983, when the chief
of internal medicine of a hospital in what was then Zaire sent a
communiqué to American health officials, informing them that a
mysterious disease seemed to have broken out among his patients. At
the time, the United States was being convulsed by its own weird
health crisis. Large numbers of gay men were coming down with an
unknown disease of extraordinary virulence, something never seen in
the West before. Scientists called it GRID, an acronym for
Gay-Related Immune Deficiency. Political conservatives and holy men
called it God’s vengeance on sinners. American researchers were thus
intrigued that a similar syndrome had been observed in heterosexuals
in Africa. A posse of seasoned disease cowboys was convened and sent
forth to investigate.
On October 18th, 1993, they walked into Kinshasa’s Mama Yemo
Hospital, led by Peter Piot, 34, a Belgian microbiologist who had
been to the institution years earlier, investigating the first
outbreak of Ebola fever. A change was immediately apparent. “In 1976,
there were hardly any young adults in orthopedic wards,” Piot told a
reporter. “Suddenly – boom – I walked in and saw all these young men
and women, emaciated, dying.” Tests confirmed his worst
apprehensions: The mysterious new disease was present in Africa, and
its victims were heterosexual. When researchers started looking for
the newly identified human immunodeficiency virus, it turned up
almost everywhere – in eighty percent of Nairobi prostitutes,
thirty-two percent of Ugandan truck drivers, forty-five percent of
hospitalized Rwandan children. Worse, it seemed to be spreading very
rapidly. Epidemiologists plotted figures on graphs, drew lines
linking the data points and gaped in horror. The epidemic curve
peaked in the stratosphere. Scores of millions – maybe more – would
die unless something was done.
These prophecies transformed the destiny of AIDS. In 1983, it was a
fairly rare disease, confined largely to the gay and heroin-using
subcultures of the West. A few years later, it was a threat to all of
humanity itself. “We stand nakedly before a pandemic as mortal as any
there has ever been,” World Health Organization chief Halfdan Mahler
told a press conference in 1986. Western governments heeded his
anguished appeal for action. Billions were invested in education and
prevention campaigns. According to the Washington Post, impoverished
AIDS researchers suddenly had budgets that outstripped their spending
capacity. Nongovernmental AIDS organizations sprang up all across
Africa – 570 of them in Zimbabwe, 300 in South Africa, 1,300 in
Uganda. By 2000, global spending on AIDS had risen to many billions
of dollars a year, and activists were urging the commitment of many
billions more, largely to counter the apocalypse in Africa, where 22
million were said to carry the virus and 14 million to have died of
it.
And this is about where I entered the picture – July 2000, three
months after South African President Thabo Mbeki announced that he
intended to convene a panel of scientists and professors to
re-examine the relationship between the human immunodeficiency virus
and AIDS. Mbeki never exactly said AIDS doesn’t exist, but his action
begged the question, and the implications were mind-bending. South
Africa was said to have more HIV infections (4.2 million) than any
other country on the planet. One in five adults were already
infected, and the toll was rising daily. As his words sank in,
disbelief turned to derision.
“Ludicrous,” said the Washington Post.
“Off his rocker,” said the Spectator.
“A little open-mindedness is fine,” said Newsday. “But a person can
be so open-minded, his brains can fall out.”
The whole world laughed, and I rubbed my hands with glee: South
Africa was back on the world’s front pages for the first time since
the fall of apartheid; fortune awaited the man of action. I went to
see a friend who happens also to be an AIDS epidemiologist. He was so
enraged by what he called the “genocidal stupidity” of Mbeki’s
initiative that he’d left work and gone home, where I found him
slumped in depression. “Hey,” I said, snap out of it. Let’s make a
deal.” And so we did: He’d talk, I’d type, and together we’d tell the
inside story of Thabo Mbeki’s AIDS fiasco. All that remained was to
consider to consider the evidence that had led our leader astray.
According to newspaper reports, Mbeki had gleaned much of what he
knew from the Web, so I revved up the laptop and followed him into
the virtual underworld of AIDS heresy, where renegade scientists
maintain Web sites dedicated to the notion that AIDS is a hoax,
dreamed up by a diabolical alliance of pharmaceutical companies and
“fascist” academics whose only interest is enriching themselves. I
visited several such sites, noted what they had to say, and then
turned to Web sites maintained by universities and governments, which
offered crushing rebuttals. Can’t say I understood everything,
because the science was deep and dense, but here’s the gist:
Look at AIDS from an African point of view. Imagine yourself in a mud
hut, or maybe a tin shack on the outskirts of some sprawling city.
There’s sewage in the streets, and refuse removal is nonexistent.
Flies and mosquitoes abound, and your drinking water is probably
contaminated with feces. You and your children are sickly,
undernourished and stalked by diseases for which you’re unlikely to
receive proper treatment. Worse yet, these diseases are mutating,
becoming more virulent and drug-resistant. Minor scourge such as
diarrhea and pneumonia respond sluggishly to antibiotics. Malaria now
shrugs off treatment with chloroquine, which is often the only drug
for it available to poor Africans. Some strains of tuberculosis -
Africa’s other great killer – have become virtually incurable. Now
atop all this is AIDS.
According to what you hear on the radio, AIDS is caused by a tiny
virus that lurks unseen in the blood for many years, only to emerge
in deep disguise: a disease whose symptoms are other diseases, like
TB, for instance. Or pneumonia. Running stomach, say, or bloody
diarrhea in babies. These diseases are not new, which is why some
Africans have always been skeptical, maintaining that AIDS actually
stands for “American Idea for Discouraging Sex.” Others say nonsense,
the scientists are right; we’re all going to die unless we use
condoms. But condoms cost money and you have none, so you just sigh
and hope for the best.
Then one day you get a cough that won’t go away, and you start
shedding weight at an alarming rate. You know these symptoms. In the
past, you could take some pills and they would usually go away. But
the medicines don’t work anymore. You get sicker and sicker. You wind
up in the AIDS ward.
The orthodox scientists, if they could see you lying there, would say
your immune system has been destroyed by HIV, allowing the
tuberculosis (or whatever) to run riot. The dissidents would say no
way – the virus is a harmless creature that just happens to accompany
immune-system breakdown caused by other factors, in this case a
lifetime of hunger and exposure to tropical pathogens.
Incensed by this, the orthodoxy whistles up a truckload of studies
from all over Africa showing that HIV-positive hospital patients die
at astronomical rates relative to their HIV-negative counterparts.
The dissidents claim to be unimpressed. This proves nothing, they say
except that dying hospital patients carry the virus.
The orthodoxy grits its teeth. There’s only one way to crush these
rebels, and that’s to show that AIDS is a new disease that has caused
a massive increase in African mortality, which is of course the truth
as we know it: 22 million Africans infected, with 14 million more
already dead from it.
These frightening numbers were all that mattered, it seemed to me.
Once they were shown to be accurate, further debate would be rendered
obscene, and Thabo Mbeki would be guilty as charged, a fool who’d
allowed himself to be swayed by a tiny band of heretics universally
dismissed as wackos, fringe lunatics and scientific psychopaths. So I
set out to confirm the death toll. Just that. I thought it would be
easy – a call or two, maybe a brief interview. I picked up the phone.
It was my first mistake.
2. A Forbidden Thought
There was a time when I imagined medical research as an idealized
endeavor, carried out by scientists interested only in truth. Up
close, it turns out to be much like any other human enterprise, riven
with envy, ambition and the standard jockeying for position. Labs and
universities depend on grants, and grant making is fickle, subject to
the vagaries of politics and intellectual fashion, and prone to favor
scientists whose work grips the popular imagination. Every disease
has champions who gather the data and proclaim the threat it poses.
The cancer fighters will tell you that their crisis is deepening, and
more research money is urgently needed. Those doing battle with
malaria make similar pronouncements, as do those working on TB, and
so on, and so on. If all their claims are added together, you wind up
with a theoretical global death toll that “exceeds the number of
humans who die annually by two- to threefold,” said Christopher
Murray, a World Health Organization director.
Malaria kills around 2 million humans a year, roughly the same number
as AIDS, but malaria research currently gets only a fraction of the
resources devoted to AIDS. Tuberculosis (1.7 million victims a year)
is similarly sidelined, to the extent that there were no new TB drugs
in development at all as of 1998. AIDS, on the other hand, is
replete, employing an estimated 100,000 scientists, sociologists,
caregivers, counselors, peer educators and stagers of condom
jamborees. Until the attacks of September 11th diverted the world’s
anxieties (and charity dollars), the level of funding for AIDS grew
daily as foundations, governments and philanthropists such as Bill
Gates entered the field, unnerved by the bad news, which usually
arrived in the form of articles describing AIDS as a “merciless
plague” of “biblical virulence,” causing “terrible depredation” (as
Time recently put it) among the world’s poorest people.
These stories all originate in Africa, but the statistics that
support them emanate from the suburbs of Geneva, where the World
Health Organization has its headquarters. Technically employed by the
United Nations, WHO officials are the world’s disease police,
dedicated to eradicating illness. They crusade against old scourges,
raise the alarm against new ones, fight epidemics, and dispense
grants and expertise to poor countries. In conjunction with UNAIDS
(the joint United Nations Program on HIV/AIDS, based at the same
Geneva campus), the WHO also collects and disseminates information
about the AIDS pandemic.
In the West, the collection of such data is a fairly simple matter:
Almost every new AIDS case is scientifically verified and reported to
government health authorities, who inform the disease police in
Geneva. But AIDS mostly occurs in Africa, where hospitals are thinly
spread, understaffed and often bereft of the laboratory equipment
necessary to confirm HIV infections. How do you track an epidemic
under these conditions? In 1985, the WHO asked experts to hammer out
a simple description of AIDS, something that would enable bush
doctors to recognize the symptoms and start counting cases, but the
outcome was a fiasco – partly because doctors struggled to diagnose
the disease with the naked eye, but mostly because African
governments were too disorganized to collect the numbers and send
them in. Once it become clear that the case-reporting system wasn’t
working, the WHO devised an alternative, by which Africa’s AIDS
statistics are now primarily based.
It works like this: On any given morning anywhere in sub-Saharan
Africa, you’ll find crowds of expectant mothers ling up outside
government prenatal clinics, waiting for a routine checkup that
includes the drawing of a blood sample to test for syphilis.
According UNAIDS, “anonymous blood specimens left over from these
tests are tested for antibodies to HIV,” a ritual that usually takes
place once a year. The results are fed into a computer model that
uses “simple back-calculation procedures” and knowledge of “the
well-known natural course of HIV infection” to produce statistics for
the continent In other words, AIDS researchers descend on selected
clinics, remove the leftover blood samples and screen them for traces
of HIV The results are forwarded to Geneva and fed into a computer
program called Epi-model: If a given number of pregnant women are
HIV-positive, the formula says, then a certain percentage of all
adults and children are presumed to be infected, too. And if that
many people are infected, it follows that a percentage of them must
have died. Hence, when UNAIDS announces 14 million Africans have
succumbed to AIDS, it does not mean 14 million infected bodies have
been counted. It means that 14 million people have theoretically
died, some of them unseen in Africa’s swamps, shantytowns and vast
swaths of terra incognita.
You can theorize at will about the rest of Africa and nobody will
ever be the wiser, but my homeland is different – we are a
semi-industrialized nation with a respectable statistical service.
“South Africa,” says Ian Timaeus, London School of Hygiene and
Tropical Medicine professor and UNAIDS consultant “is the only
country in sub-Saharan Africa where sufficient deaths are routinely
registered to attempt to produce national estimates of mortality from
this source.” He adds that, “coverage is far from complete,” but
there’s enough of it to be useful – around eight of ten deaths are
routinely registered in South Africa, according to Timaeus, compared
to about 1 in 100 elsewhere below the Sahara.
It therefore seemed to me that checking the number of registered
deaths in South Africa was the surest way of assessing the statistics
from Geneva, so I dug out the figures. Geneva’s computer models
suggested that AIDS deaths here had tripled in three years, surging
from 80,000-odd in 1996 to 250,000 in 1999. But no such rise was
discernable in total registered deaths, which went from 294,703 to
343,535 within roughly the same period. The discrepancy was so large
that I wrote to make absolutely sure I had understood these numbers
correctly. Both parties confirmed that I had, and at that exact
moment, my story was in trouble. Geneva’s figures reflected
catastrophe. Pretoria’s figures did not. Between these extremes lay a
gray area populated by local experts such as Stephen Kramer, manager
of insurance giant Metropolitan’s AIDS Research Unit, whose own
computer model shows AIDS deaths at about one-third Geneva’s
estimates. But so what? South African actuaries don’t get a say in
this debate. The figures you see in your newspapers come from Geneva.
The WHO takes pains to label these numbers estimates only, not
rock-solid certainties, but still, these are estimates we all accept
as the truth.
But you don’t want to hear this, do you? Nor did I. It spoiled the
plot, so I tried to ignore it. Since it was indeed true that the very
large numbers of South Africans were dying, then the nation’s coffin
makers had to be laboring hard to keep pace with growing demand. One
newspaper account I found told of a company called Affordable
Coffins, purveyor of cheap cardboard caskets, which had more orders
than it could fill. But the firm was barely two months old when the
story ran, and two rival entrepreneurs who launched similar products
a few years back had gone under. “People weren’t interested,†said a
dejected Mr. Rob Whyte. “They wanted coffins made of real wood.”
So I called the real-wood firms, three industrialists who
manufactured coffins on an assembly line for the national market.
“It’s quiet,” said Kurt Lammerding of GNG Pine Products. His
competitors concurred – business was dead, so to speak.
“It’s a fact,” said Mr. A. B. Schwegman of B&A Coffins. “If you go on
what you read in the papers, we should be overwhelmed, but there’s
nothing. So what’s going on? You tell me.”
I couldn’t, although I suspected it might have something to do with
race. Since the downfall of apartheid, in 1994, illegal backyard
funeral parlors have mushroomed in the black townships, and my
sources couldn’t discount the possibility that these outfits were
scoring their coffins from the underground economy. So, I called a
black-owned firm, Mmabatho Coffins, but it had gone out of business,
along with some others I tried calling. This was getting seriously
weird. The death rate had almost doubled in the past decade,
according to a recent story in South Africa’s largest newspaper.
“These aren’t projections,” said the Sunday Times. “These are the
facts.” And if the facts were correct, I thought, someone somewhere
had to be prospering in the coffin trade.
Further inquiries led me to Johannesburg’s derelict downtown, where a
giant multistory parking garage has recently been transformed into a
vast warren of carpentry workshops, each housing a black carpenter,
set up in business with government seed money. I wandered around
searching for coffin makers, but there were only two. Eric Borman
said business was good, but he was a master craftsman who made one or
two deluxe caskets a week and seemed to resent the suggestion his
customers were the sort of people who died of AIDS. For that, I’d
have to talk to Penny. Borman pointed, and off I went, deeper and
deeper into the maze. Penny’s place was locked up and deserted.
Inside, I saw unsold coffins stacked ceiling-high, and a forlorn
CLOSED sign hung on a wire.
At that moment, a forbidden thought entered my brain. This may sound
crazy to you, thousands of miles away, but put yourself in my shoes.
You live in Africa – OK, in the post-colonial twilight of
Johannesburg’s once-white suburbs, but still, close enough to the
AIDS front line. For years, experts tell you that the plague is
marching down the continent, coming ever closer. At first nothing
happens, but there dawns a day when the HIV estimates start rising
around you, and by 2000 the newspapers are telling you that one in
five adults on your street is walking dead.
This has to be true, because it’s coming from experts, so you start
looking for evidence. Laston, the gardener at Number 10, is
suspiciously thin, and has a hacking cough that won’t go away. On the
far side of the golf course, Mrs. Smith has just buried her beloved
servant. Mr. Beresford’s maid has just died, too. Your cousin Lenny
knows someone who owns a factory where all the workers are dying.
Your newspapers are regularly predicting that the economy will surely
be crippled, and schooling may soon collapse because so many teachers
have died.
But then you find yourself staring into Penny’s failed coffin
workshop and you think, Jesus, maybe something is wrong here…
Is this likely? Look, I believe that AIDS exists and it’s killing
Africans. But as many as all the experts tell us? Hard to say. In my
suburb, I can assure you, people’s brains are so addled by death
propaganda that we automatically assume almost everyone who falls
seriously ill or dies has AIDS, especially if they’re poor and black.
But we don’t really know for sure, and nor do the sufferers
themselves, because hardly anyone has been tested. “What’s the
point?” asks Laston, the ailing gardener. He knows there’s no cure
for AIDS, and no hope of obtaining life-extending anti-retrovirals.
Last winter, he came down with a bad cough, and everyone said it was
AIDS, but it wasn’t – come summer, Laston got better. Then Stanley
the bricklayer became our street’s most likely case. Stan maintained
he had a heart condition, but behind his back, everyone was
whispering, “Oh, my God, it’s AIDS.” But was it? We had no idea. We
were playing a game, driven by hysteria.
No one wanted to hear this. Worried friends slipped newspaper
clippings into my mailbox: CEMETERY OVERFLOWS…. HOSPITALS
OVERWHELMED…. PRISON DEATHS UP 535 PERCENT. I checked out all the
evidence, but often there was some other possible explanation, like
cut-price burial plots or a TB epidemic in the overcrowded jails or a
funding crisis in government hospitals. After months of this, even my
mother lost patience. “Shut up!” she snapped. “They’ll put you in a
straitjacket.” Mother knows best, but I just couldn’t get those
numbers out of my head: 294,703 registered deaths in 1996, 343,535
four years later. I called my friend the AIDS epidemiologist and
said, “Listen, I am beset by demons and heresies, can you not save
me?” So we had lunch, and I aired my doubts, whereupon he pointed in
the direction where truth lay, and I set out to find it.
3. A Bell is Rung
And here we are on a hilltop on the equator, overlooking the
landscape where Africa’s first recorded outbreak of AIDS took place.
It’s a village called Kashenye, which lies on the border between
Uganda and Tanzania, close to where the Kagera River flows into Lake
Victoria. In 1979 or thereabouts, according to local legend, a trader
crossed the river in a canoe to sell his wares in Kashenye. Business
done, he bought some beers and relaxed in the company of a village
girl. Some time later, she fell victim to a wasting disease that
refused to respond to any known medication, Western or tribal.
Not long after, according to Edward Hooper in his book Slim, a
similar drama unfolded in Kasensero, a fishing village over on the
Uganda side of the river. There the first victim was also a local
girl, and the agent of infection was said to have been a visitor from
Kashenye. In due course, several more citizens of Kashenye contracted
the wasting disease. Their neighbors cried foul, accusing Kashenye of
putting a hex on them. Kashenye responded with similar allegations.
Soon, villagers on both banks of the river were discarding objects
brought from the other side, believing them to be bewitched. But
nothing helped. By 1983, the contagion was in all the cities on the
Western shore of Lake Victoria. Within a few years the region became
known as the epicenter of Africa’s AIDS epidemic, and Ugandan
president Yoweri Museveni was predicting that “apocalypse” was
imminent.
His prophecy was based largely on testing done among small groups of
high-risk subjects. Many factors were unknown, however, including the
true extent of infection in the general populace, the rate at which
it was spreading, the speed at which it killed. To formulate an
effective battle plan, AIDS researchers desperately needed more data
in these areas.
They cast around for a place to study, and lit on the Masaka district
in Uganda, a ramshackle area just west of Lake Victoria and probably
100 miles north of Ground Zero. The rate of infection there among
adults was not particularly high – just more than eight percent – but
there were other considerations making it a good place to study: The
district was politically stable, and there was an international
airport three hours away. In 1989, a Dutch epidemiologist named Daan
Mulder began to lay the groundwork for what would ultimately become
the longest and most important study of its kind in Africa.
Assisted by an army of field workers, Mulder drew a circle around
fifteen villages outside Masaka and proceeded to count every
resident. Then he took blood from all those who were willing – 8,833
out of 9,777 inhabitants – screened it for HIV infections and sat
back to see what happened. Every household was visited at least once
a year, and every death was noted and entered into Mulder’s database,
along with the deceased’s HIV status.
The first results were published in 1994, and they were devastating.
The HIV-infected villagers of Masaka were dying at a rate fifteen
times higher than their uninfected neighbors. Young adults with the
virus in their bloodstream were sixty times more likely to perish.
Overall, HIV-related disease accounted for a staggering forty-two
percent of all deaths. The AIDS dissidents were crushed, HIV theory
was vindicated. “If there are any left who will not even accept
[this],” commented the U.S. Centers for Disease Control upon the
release of the results, “their explanation of how HIV-seropositivity
leads to early death must be very curious indeed.”
Clearly, only a fool would second-guess such powerful evidence, so I
just visited the villages where Mulder’s work was done, verified what
he’d found and headed back toward the airport, my story about Mbeki’s
stupidity back on track. But on my way I spent an hour or two in
Uganda’s Statistics Office, and what I learned there changed things
yet again.
In 1948, Uganda’s British rulers attempted a rough census in the
Masaka area and concluded that the annual death rate was “a minimum
of twenty-five to thirty per thousand.” A second census, in 1959, put
the figure at twenty-one deaths per thousand. By 1991, it had fallen
to sixteen per thousand. Enter Daan Mulder with his blood tests,
massive funding and armies of field workers. He counted every death
over two years, and then five, and here is his conclusion: The crude
annual death rate in Masaka, in the midst of a horrifying AIDS
plague, was 14.6 per thousand – the lowest ever measured.
I was relieved to discover that there was another possible
interpretation of these statistics. Daan Mulder’s work began at a
time when Uganda was emerging from two decades of terror and chaos.
Doctors had fled the country, hospitals had collapsed and nobody kept
track of mortality trends in the dark years of the Seventies and
Eighties. According to British statistician Andrew Nunn, one of
Mulder’s collaborators, disease-related rates must have fallen to
all-time low levels in the Seventies, when no one was counting, and
then surged massively with the advent of AIDS around 1980.
“In fact,” says Nunn, “evidence suggests it’s epidemic.” (Mulder
himself cannot be asked to explain his findings – he has since died
of cancer.)
Nunn’s explanation may be so, but the same can’t apply to neighboring
Tanzania, which embarked in 1992 on an even larger mortality study.
Like Mulder’s, it was funded by the British government and supported
by scientists from the British universities. The Adult Morbidity and
Mortality Project recruited 307,912 participants, each of whom was
visited at least once a year in the next three years and questioned
about recent deaths or disease. The final results were rather like
Masaka’s: AIDS was the leading reported cause of adult mortality, but
the average death rate in the communities studied was 13.6 per
thousand – ten percent lower than the death rate measured in the
census of 1988, which was rated “close to 100 percent” complete by
Dr. Timaeus, the UNAIDS consultant. Timaeus is a leading authority on
African mortality in the AIDS era, and it was to him that my
difficult question ultimately fell.
Professor Timaeus,” I said in his London office, “this study appears
to show that there was no increase in the death rate between 1988 and
1995, in the heart of Tanzania’s AIDS epidemic.”
He shrugged. “This survey covered only part of the country,” he said.
“True,” I said, “but a fairly large part, with hundreds of thousands
of participants.”
“But were they representative?” he countered.
I had no idea. Timaeus smiled and said, “I think this is the more
critical evidence.”
Whereupon he produced a sheath of graphs and papers and laid them on
the table. There was, he said, a “regrettable” lack of knowledge
about mortality trends in Africa, attributable to “inertia,”
indifference and a crippling lack of up-to-date data. These factors
bedeviled the demographer, but Timaeus said he knew of several ways
around them, most dramatic of which is the so-called sibling-history
technique of mortality estimation. It works like this:
Since 1984, researchers financed by the U.S. Agency for International
Development have conducted detailed health interviews with several
thousand mothers in developing countries worldwide. Among the
questions put to them are these: How many children did your mother
have? How many are still alive? When did the others die? Timaeus
realized that close analysis of the answers might reveal trends that
were failing to show up elsewhere. He set to work, and published the
results in the journal AIDS in 1998. “In just six years (1989-1995)
in Uganda,” he wrote, “men’s death rates more than doubled.” Similar
trends were revealed in Tanzania, he reported, where “men’s deaths
apparently rose eighty percent” in the same period.
Again, this seemed to settle the matter, but again, there were
puzzling complications. For a start, Timaeus’ study coincided with
Daan Mulder’s epic mortality study, which ran for seven years without
detecting any significant change in the death rate. The same is true
of Tanzania’s giant adult-mortality survey, which fell in the heart
of the period when Timaeus says male mortality was surging upward but
which failed to document any such thing.
Could there have been some problem with Timaeus’ data? Kenneth Hill
is the Johns Hopkins university demographer who helped conceive the
sibling-history technique. Recently, he and his team embarked on a
worldwide evaluation of its performance in the field, to check on its
accuracy. Last year, an article co-authored by Hill reported that the
method was prone to something called, “downward bias” – meaning that
people remember recent deaths pretty clearly, but those from years
back tend to fade. According to the article, which appeared in
Studies in Family Planning, this usually leads to a false impression
of rising mortality rates as you near the present. This has happened
even in counties where there was little or no AIDS. In Namibia, for
instance, the sibling method detected a 156 percent rise in the
fourteen years prior to 1992, when the country’s HIV infection rate
ranged from zero to one percent. “This lack of precision,” Hill and
his associate wrote, “precludes the use of these data for trend
analysis.”
“I disagree,” said Timaeus, who believes they got their math wrong.
Neither Hill nor any members of his team wanted to respond on the
record, but I drew one of them into a conversation on another subject.
“Do you accept the high levels of HIV infection being reported by
Geneva?” I asked.
“I don’t have much faith,” he said. “It’s essentially a modeling
exercise, and the exercise has always seemed to have a political
dimension.”
That rung a bell. I was living in Los Angeles in 1981, when the very
first cases of GRID were detected. I knew men who were stricken, and
I sympathized entirely with their desperation. They wanted government
action and knew there would be little as long as the disease was seen
as a scourge of queers, junkies and Haitians. So they forged an
alliance with powerful figures in science and the media and set forth
to change perceptions, armed inter alia with potent slogans such as
“AIDS is an equal-opportunity killer” and “AIDS threatens everyone.”
Madonna, Liz Taylor and other stars were recruited to drive home the
message to the straight masses: AIDS is coming after you, too.
These warnings were backed up by estimates such as the one issued by
the CDC in 1985, stating that 1.5 million Americans were already
HIV-infected, and the disease was spreading rapidly. Dr Anthony
Fauci, now head of the National Institute of Allergic and Infectious
diseases, prophesied that “2 to 3 million Americans” would be
HIV-positive within a decade. Newsweek’s figures in a 1986 article
were at least twice as high. That same year, Oprah Winfrey told the
nation that “by 1990 one in five” heterosexuals would be dead of
AIDS. As the hysteria intensified, challenging such certainties came
to be dangerous. In 1988 New York City Health Commissioner Stephen C.
Joseph reviewed the city’s estimate of HIV infections, concluded that
the number was inaccurate and halved it, from 400,000 to 200,000. His
office was invaded by protesters, his life threatened. Demonstrators
tailed him to meetings, chanting, “Resign, resign!”
In hindsight, Dr. Joseph’s reduced figure of 200,000 might itself be
an exaggeration, given that New York City has recorded a total of
around 120,000 AIDS cases since the start of the epidemic two decades
ago. In 1997, a federal health official told the Washington Post that
by his calculation, the true number of HIV infections in the United
States back in the mid-Eighties must have been around 450,000 – less
than one-third of the figure put forth at the time by the CDC.
If the numbers could be gotten so wrong in America, what are we to
make of the infinitely more dire death spells cast upon the
developing world? In 1993, Laurie Garrett wrote in her book The
Coming Plague that Thailand’s AIDS epidemic was “moving at
super-sonic speed.” It has stalled at just below two percent,
according to UNAIDS. In 1991 All India Institute of Medical Sciences
official Vulmiri Ramalingaswami said AIDS in India “was sitting on
top of a volcano,” but infection levels there have yet to crest one
percent. The only place where the AIDS apocalypse has materialized in
its full and ghastly glory is in Geneva’s computer models of the
African pandemic, which show millions dead and far worse coming.
Why Africa, and Africa only? I now know a possible reason. Read on.
4. “Crap!” An Expert Declares
In many ways, the story of AIDS in Africa is a story of the gulf
between rich and poor, the privileged and the wretched. Here is one
way of calibrating the abyss.
Let’s say you live in America, and you committed an indiscretion with
drugs and needles or unprotected sex a few years back, and now find
yourself plagued by ominous maladies that won’t go away. Your doctor
frowns and says you should have an AIDS test. She draws a blood
sample and sends it to a laboratory, where it is subjected to an
exploratory ELISA (enzyme-linked immunosorbent assay) test. The ELISA
cannot detect the virus itself, only the antibodies that mark its
presence. If your blood contains such antibodies, the test will
“light up,” or change color, whereupon the lab tech will repeat the
experiment. If the second ELISA lights up, too, he’ll do a
confirmatory test using the more sophisticated and expensive Western
Blot method. And if that confirms the infection, the Centers for
Disease Control recommends that the entire procedure be repeated
using a new blood sample, to put the outcome beyond all doubt.
In other words, we’re talking six tests in all, doubly confirmed.
Such a protocol is probably foolproof, but as you draw away from the
First World, health-care standards decline and people grow poorer,
meaning that confirmatory tests become prohibitively expensive. In
Johannesburg, for instance, a doctor in private practice will
typically want three consecutive positive ELISAs before deciding that
you are HIV-positive. But his counterpart in a government-sponsored
testing center has to settle for two ELISA tests.
In the annual pregnancy-clinic surveys on which South Africa’s
terrifying AIDS statistics are based, the protocol is one ELISA only,
unconfirmed by anything. In America one ELISA means almost nothing.
“Persons are positive only when they are repeatedly reactive by ELISA
and confirmed by Western Blot,” says the CDC. The companies that
manufacture ELISAs agree: The tests must be confirmed by other means.
“Repeatedly reactive specimens may contain antibodies” to HIV, one
firm’s literature says, “Therefore additional, more specific tests
must be run to verify a positive result.”
In parts of Africa, however, at least for the purpose of data
gathering, such precautions are deemed unnecessary. That’s partly
because the World Health Organization itself actually evaluates
commercial HIV tests as they come on the market. In these trials, new
tests are measured against a panel of several hundred blood samples
from all over the world. Some of the samples are HIV-positive, some
are not. The ELISAs are tested to make sure they can tell which are
which. Among the scores of brands evaluated throughout the years, a
handful have proved to be useless. But those manufactured by
established biotechnology corporations usually pass with flying
colors, typically scoring accuracy rates close to perfect.
In South Africa, such outcomes were often cited in furious attacks on
President Mbeki. “HIV tests such as the latest-generation ELISA are
now more than ninety-nine percent accurate.” reported the Weekly Mail
and Guardian. The tests have confidence levels of 99.9 percent, said
professor Malegapuru Makoba, head of the Medical Research Council.
Science had spoken, and science was unanimous: The tests were fine,
and Mbeki was a fool, according to the Weekly Mail, “trying to be a
Boy’s Own basement lab hero of AIDS science.”
It was a good line. I laughed, too, but there came a moment when it
ceased to be funny.
My education in the complexities of the ELISA test started when I
came across an article in a scientific journal published last year.
It told a story that began in 1994, when researchers ran HIV tests on
184 high-risk subjects in a South African mining camp. Twenty-one of
the subjects came up positive or borderline positive on at least one
ELISA. But the results were confusing: A locally manufactured test
indicated seven, but different people in almost every case. A French
test declared fourteen were infected.
It seemed something was confounding the tests, and the prime suspect
was plasmodium falciparum, one of the parasites that causes malaria:
Of the twenty-one subjects who tested positive, sixteen had had
recent malaria infections and huge levels of antibody in their veins.
The researchers tried an experiment: They formulated a preparation
that absorbed the malaria antibodies, treated the blood samples with
it, then retested them. Eighty percent of the suspected HIV
infections vanished.
The researchers themselves admitted that these findings were
inconclusive. Still, considering that Africa is home to an estimated
ninety percent of the world’s malaria cases, the implications of the
report seemed intriguing. I asked Dr. Luc Noel, the WHO’s
blood-transfusion-safety chief, for his opinion. He insisted there
was no cause for concern. Then he handed me a booklet detailing the
outcome of the WHO’s evaluation of commercial ELISA assays. In it, I
found two of the three tests that had been used in South America -
the very ones that supposedly went haywire, kits manufactured in
Britain and France, respectively. One was rated By WHO as
ninety-seven percent accurate, the other, ninety-eight percent.
On the other hand, I couldn’t help noticing that according to the
literature Noel had given me, the disease police apply at least five
confirmatory tests to every blood sample before such high accuracy
rates are achieved. What happens if you use just two, or one? And if
your subjects are Africans whose immune systems are often, as UNAIDS
head Peter Piot once phrased it, “in a chronically activated state
associated with chronic viral and parasitic exposure.” There may be
an answer of sorts.
The Uganda Virus Research Institute is possibly Africa’s greatest
citadel of HIV studies. Seated on a hilltop overlooking Lake Victoria
and generously funded by the British government, the UVRI employs
around 200 scientists and support personnel, runs an array of
advanced AIDS studies, tests experimental drugs, labors to produce an
AIDS vaccine and has generated scores of scientific papers during the
past decade.
In 1999, the Institute screened thousands of blood samples using
ELISA tests that have achieved excellent results in a WHO evaluation.
Test-driven in a lab in Antwerp, Belgium, one test scored 99.1
percent accuracy, while the other achieved a perfect 100. But in the
field, in Africa, it was another story entirely. There, exactly 3,369
samples came up positive on one ELISA, but only 2,237 of those (66
percent) remained positive after confirmatory testing. In other
words: a third of Ugandans who tested positive on at least one of
these supposedly near-perfect ELISAs were not carrying the virus.
What does this say about countries where AIDS statistics are based on
a single ELISA? A high-ranking source at UVRI – one who insisted on
anonymity – said that the WHO estimates for AIDS in such countries
“could be as much as one-third higher than they actually are.”
I took this up with Dr. Neff Walker, a senior adviser at UNAIDS, who
at first seemed puzzled. “The standard WHO/UNAIDS protocol calls for
two tests in countries with a higher prevalence,” he said.
But according to a WHO report, “Confirmation by a second test is
necessary only in settings where estimated HIV prevalence is known to
be less than ten percent.” This means that in countries like mine,
estimates are based on one unconfirmed test.
Dr. Walker conceded that, but said it wasn’t particularly important
given that most African counties have what he called “quality
assurance” programs in place.
“I feel,” he said, “that if a government found any evidence of too
many false positives in their testing, they would report it.
Governments would like to find evidence of a lower prevalence, as
would we all, and since they have the data to easily check your
hypothesis, they would do so and report it.”
But would they? High AIDS numbers are not entirely undesirable in
poverty-stricken African countries. High numbers mean deepening
crisis, and crisis typically generates cash. The results are now
manifest: plane loads of safari scientists flying in to oversee
research projects or cutting-edge interventions, and bringing with
them huge inflows of foreign currency – about $1 billion a year in
AIDS-related funding, and most of it destined for the countries with
the highest numbers of infected citizens.
On the ground, these dollars translate into patronage for politicians
and good jobs for their struggling constituents. In Uganda, an AIDS
counselor earns twenty times more than a schoolteacher. In Tanzania,
AIDS doctors can increase their income just by saving the
hard-currency per diems they earn while attending international
conferences. Here in South Africa, entrepreneurs are piling into the
AIDS business at an astonishing rate, setting up consultancies,
selling herbal immune boosters and vitamin supplements, devising new
insurance products, distributing condoms, staging benefits, forming
theater troupes that take the AIDS prevention message into schools. A
friend of mine is co-producing a slew of TV documentaries about AIDS,
all for foreign markets. Another friend has got his fingers crossed,
since his agency is on the shortlist to land a $6 million safe-sex ad
campaign.
Sometimes it seemed I was the only one in South Africa who found this
odd. Dr. Ed Rybicki, a University of Cape Town microbiologist, caught
sight of part of this article while it was being prepared and found
it alarming. “Vast inflation of HIV figures by bad tests?” he wrote
in an email. “Naaaaah. The test manufacturers have done a hell of a
lot of research, which is not published because it is part of quality
control, rather than part of a global cartel conspiracy to make
Africans HIV-positive!” He allowed that there was “probably some
truth” in stories about “various factors confusing the HIV test” but
accused me of stringing them together in an irresponsible way.
“Crap!” he ultimately declared. “Utter garbage.”
I defer to Dr. Rybicki in matters of science, but his denunciation
rested on the flawed assumption that, as he wrote to me, “In South
Africa, tests are repeated, and repeat positives are confirmed by
another method, meaning there is a threefold redundancy.” Maybe
that’s how it works in universities or research labs. But when it
comes to UNAIDS statistics, one test is evidently enough.
5. Can You Wait Ten Years?
And so we return to where we started, standing over a coffin under a
bleak Soweto sky, making a clumsy speech about a sad and premature
death. Adelaide Ntsele died of AIDS, but the word didn’t appear on
her death certificate. Here in Africa, those little letters
stigmatize, so doctors usually put down something gentler to spare
the family further pain. In Adelaide’s case, they wrote TB. But her
sister Elizabeth had no such need of such false consolation. She
donned a red-ribbon baseball cap and appeared on national TV, telling
the truth: “My sister had HIV/AIDS.” As a nurse, Elizabeth had no
qualms with the doctors’ diagnosis, and she concurred with their
decision to forgo surgery and let Adelaide die. “It was God’s will,”
she says, and she was at peace with it. I was the one beset by all
the doubts.
Did Adelaide really die of AIDS? It certainly looked that way, but
she also had TB, the second-most-frightening disease in the world
today, on the rise everywhere, even in rich countries, sometimes in a
virulent drug-resistant form that kills half its victims, according
to the CIA’s recent report on infectious disease. Eight years ago,
the WHO declared resurgent TB a “global emergency,” but the contagion
continues to spread, particularly in the cluster of southern African
countries simultaneously stricken by the worst TB and HIV epidemics
on the planet. It takes a blood test to establish the underlying
presence of an HIV infection in people with TB, and at least one
scientist who knows about these things has imputed that the tests
might not be entirely reliable.
Back in 1994, Max Essex, head of the Harvard AIDS Institute, and some
colleagues of his observed a “very high” (sixty-three percent) rate
of ELISA false positives among lepers in central Africa. Mystified,
they probed deeper and pinpointed the cause: two cross-reacting
antigens, one of which, lipoarabinomannan, or LAM, also occurs in the
organism that causes TB. This prompted Essex and his collaborators to
warn that ELISA results should be “interpreted with caution” in areas
where HIV and TB were co-endemic. Indeed, they speculated that
existing antibody tests “may not be sufficient for HIV diagnosis” in
settings where TB and related diseases are commonplace.
Essex was not alone in warning us that antibody tests can be confused
by diseases and conditions having nothing to do with HIV and AIDS. An
article in the Journal of the American Medical Association in 1996
said that “false-positive results can be caused by nonspecific
reactions in persons with immunologic disturbances (e.g., systemic
lupus erythematosus or rheumatoid arthritis), multiple transfusions
or recent influenza or rabies vaccination…. To prevent the serious
consequences of a false-positive diagnosis of HIV infection,
confirmation of positive ELISA results is necessary…. In practice,
false-positive diagnoses can result form contaminated or mislabeled
specimens, cross-reacting antibodies, failure to perform confirmatory
tests…. or misunderstanding of reported results by clinicians or
patients.” These are not the only factors that can cause false
positives. How about pregnancy? The U.S. National Institutes of
Health states that multiple pregnancies can confuse HIV tests. In the
past few years, similar claims have been made for measles, dengue
fever, Ebola, Marburg and malaria (again).
But let’s put all that science aside, for a moment. Lots of people
thought it was wrong for me even to pose questions such as these,
especially at a moment when rich countries, rich corporations and
rich men were considering billion-dollar contributions to a Global
AIDS Superfund. They were brought to this point by a ceaseless
barrage of stories and images of unbearable suffering in Africa, all
buttressed by Geneva’s death projections. Casting doubt on those
estimates was tantamount to murder, or so said Dr, Rybicki, the Cape
Town microbiologist.
“AIDS is real, and is killing Africans in very large numbers,” he
wrote. “Presenting arguments that purport to show otherwise in the
popular press is simply going to compound the damage already done by
Mbeki. And a lot more people may die who may not have otherwise.”
Rybicki was right. But what are the facts? After a year of looking, I
still can’t say for sure.
When I embarked on this story, you may recall, no massive rise in
registered deaths was discernable in South Africa. A year later, I
decided to return to my point of departure to see if the discrepancy
persisted. I wrote to the country’s Department of Home Affairs, which
manages the death register, and asked for the latest numbers. In
response came a set of figures somewhat different from those
initially provided – the consequence, I am told of people who died
without any identity documents. Here is the final analysis:
Deaths registered in 1996 – 363,238.
Deaths registered in 2000 – 457,335.
As you see, registered deaths have indeed risen – not to the extent
prophesied by the United Nations, perhaps, but there is definite
movement in an ominous direction. Deaths are up across the board, but
concentrated in certain critical age groups: females in their
twenties, and males age thirty to thirty-nine.
A team of experts commissioned by the Medical Research Council has
studied this changing death pattern and found it to be “largely
consistent with the pattern predicted by [ours] and other models of
the AIDS epidemic.” Their conclusion: AIDS has become the “biggest
cause” of mortality in South Africa, responsible for forty percent of
adult deaths.
And yet, and yet, and yet, even this is not the end of our tale,
because another governmental body, Stats SA, has challenged these
findings. The Washington Post reported that the South African census
bureau called the MRC study “badly flawed,” saying “the samples were
not representative, and assumptions about the probability of the
transmission of the virus that causes AIDS were not necessarily
accurate.”
And that’s my story: enigma upon enigma, riddle leading to riddle,
and no reprieve from doubt. Local actuarial models say 352,000 South
Africans have died from AIDS since the epidemic began. The MRC says
517,000. The figure from a group I haven’t even mentioned yet, the
United Nations Population Division, is double that – 1.06 million -
and the unofficial WHO/UNAIDS projections are even higher. I have
wasted a year of my time and thousands of Rolling Stone’s
editorial-budget dollars, and all I can really tell you is that my
faith in science has been dented. These guys can’t agree on anything.
Ordinary Africans everywhere see that the scourge is moving among
them. The guide who showed me around Uganda had lost two siblings.
Our driver had lost three. On the banks of the Kagera River, where
the plague began, we met a sad old man who said all five of his
children had died of it.
But ask these people about access to health care, and they laugh
ruefully. “The coffee price is collapsing,” they say. No one has
money. We can’t even afford transport to hospital, let alone
medicine.” All across rural east Africa, doctors confirmed the
charge: no money, no medicine. Even mission hospitals now ask
patients for money.
“What can we do?” asks Father Boniface Kaayabula, who works at a
Catholic mission in rural Uganda. “We have no money, too. We must ask
people to pay, and only a very few can.”
So what do poor Africans do if they fall sick? They go to roadside
shacks called “drug stores” and buy snake oil. Chloroquine for
malaria, on a continent where that former miracle drug has lost most
of its curative power; nameless black-market antibiotics for lung
diseases, in a setting where up to sixty percent of pneumonia is
drug-resistant; penicillin for gonorrhea, administered by an amateur
“injectionist” who might be unaware that the quantity needed to knock
out the infection has risen a hundredfold in the past decade. For the
poorest of the poor, even such dubious nostrums are beyond reach.
They try to cure themselves with herbs, they fail, and they die.
What’s to be done? Dr. Joseph Sonnabend is a South Africa-born
physician who was running a venereal-disease clinic in New York back
in the early Eighties, when GRID first appeared. He became known
throughout the world as a pioneer in AIDS treatment. When President
Mbeki launched his controversial inquiry into the disease last year,
Sonnabend came home to participate, an experience he likens to
“entering hell.”
As founder of the AIDS Medical Foundation, which became the American
AIDS Research Foundation, or AmFAR, Sonnabend has no patience with
those dissidents who dispute the syndrome’s existence or HIV’s power
to cause it. But he also believes there are “opportunists” and
“phonies” whose chief skill is “manipulation of fear for advancement
in terms of money and power.” In fact, he quit AmFAR, his own group,
because he felt it was exaggerating the threat of a heterosexual
epidemic. A decade later, he’s still fighting the lonely battle for
wise policies, especially in Africa.
In Pretoria, he says, one faction argued for the bulk of available
funds to be committed to the purchase of AIDS drugs. But merely
dumping AIDS drugs into resource-poor countries is pointless,
Sonnabend argued, although he does believe there are limited
situations where they could be safely and effectively used. The
prevention of mother-to-child transmission is one; another is in
people with advanced disease where facilities to adequately monitor
the use of drugs are in place. Unfortunately, the cost of
establishing an infrastructure to do this on a large scale would be
enormous, and without this hardly anyone would benefit, save drug
manufacturers.
The answer, he feels, is to eliminate conditions that render Africans
vulnerable to HIV in the first place. A year down the line, Sonnabend
is still trying to organize an international conference to discuss
the disposition of the money lodged in the Global AIDS Superfund. The
way he sees it, $1 billion a year would be enough to transform the
lives of ordinary Africans and curb the AIDS epidemic, but only if
it’s not squandered on unsustainable “drugs into people” programs.
“There’s a place for AIDS drugs and prevention campaigns,” he says,
“but it’s not the only answer. We need to roll out clean water and
proper sanitation. Do something about nutrition. Put in some basic
health infrastructure. Develop effective drugs for malaria and TB and
get them to everyone who needs them.”
On the other hand, we have researchers like the ones from Harvard
University who insist that biomedical intervention is morally
inescapable. “We can raise people from their deathbeds,” said
professor Bruce Walker. They calculated that it should be possible to
provide Africans with AIDS drugs for as little as $1,100 a year.
Granted, says Sonnabend, but this makes little sense if that one
lucky person’s neighbors are dying for lack of medicines that cost a
few cents.
So who’s right? Depends on the numbers, I guess. In the end, I
attempted to bring all my unanswered questions on that topic to the
man who was there when the epidemic first hit this continent, Dr.
Peter Piot, who has today risen to the role of chief of UNAIDS.
But my call to him was directed instead to UNAIDS’ chief
epidemiologist, a physician named Dr. Bernhard Schwartlander.
The UNAIDS computer model of Africa’s epidemic is in fact completely
dependable, Dr. Schwartlander says because it relies on a “very
simple formula. You take the pregnancy-clinic numbers. You take the
median survival time – around nine years in Africa. You say this is
roughly the distribution curve. Calculation of deaths is completely
plausible if – and this is important – you have a good idea of the
prevalence of HIV and how it spreads over time.”
Why then, I asked, do we have so many different estimates of AIDS
deaths in South Africa?
“I’m not shocked,” he said. “The models may completely disagree at a
particular point in time, but in the end the curves look incredibly
similar. They’re goddamn consistent.”
If that’s true, I said, then why would we have 457,000 registered
deaths here last year when the UN says 400,000 of them died of AIDS?
One of those numbers must be wrong.
“You say there are 457,000 registered deaths in South Africa?”
Schwartlander said, momentarily nonplussed. “This is an estimate
based on projections.”
No, said I, it’s the actual number of registered deaths last year.
“We don’t really know,” he replied. “Things are moving very fast.
What is the total number of people who actually die? For all we know,
it could be much higher. HIV has never existed in mankind before, and
there’s no anchor point set in stone.” The UNAIDS numbers are, after
all, only estimates. We are not saying this is the number. We are
saying this is our best estimate. Ten years from now, we won’t have
these problems. Ten years from now, we’ll know everything.”
Ten years! Had I known, I could have saved myself a lot of grief. For
even as I tried to track down the old numbers, bigger new ones were
supplanting them – 17 million Africans dead of AIDS and 25 million
more with HIV, UNAIDS now estimates; not one in five South African
adults infected but one in four. Are these numbers right? Who knows?
Rian Malan is the author of “My Traitor’s Heart: A South African
Exile Returns to Face His Country, His Tribe and His Conscience.”
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This is my battle with John Maddox [editor of Nature] and with people who are actually fabricating the data [Ascher et al in Nature, March 11, 1993]. They claim to have such a group that had not used any drugs. When I analyzed the data, it turned out that there was not a single person in their paper that was drug-free. I submitted a critique to Maddox, but his response was, I could no longer respond. I was censored. – Peter Duesberg (left), interview with Bob Guccione, Spin magazine, September, 1993.
Herd instinct, hindsight bias, homophobia, hubris, human error, hypocrisy, haste, Inattention blindness, iatrogenic ignorance, ideology, indoctrination, illogic, instigating panic, institutional affiliation, intimidation, irrationality, insanity,
Job seeking, job retention, just world prejudice, Kowtowing to seniority and power, Lack of controls, labeling, laziness, lickspittle press instincts, loyalty to superiors, lying, lynch mob mentality, Maintaining parents, wives, mistresses and offspring, masochism, media stenography, mental inertia, mentor allegiance, misdirection, misunderstanding, Naivete, narcissism, Nobel hunting, normalcy bias, Obedience, obeisance, officiousness, opportunism, overclaiming, operant conditioning, Panic, priming, publication bias, paradigm protection, patron pandering, peer pressure, perks, preconceptions, presentation bias, privileges, prizes, piety, politicking, political pressures, popularity, power seeking, pseudoscience, prejudice, preserving face, prevarication, pride, protectionism, Ptolemaic rationalizing, public relations, PubMed illiteracy, pusillanimity, psychopathy, Racism, rage, rationalization, religion, religious instinct, respectability, reputation enhancing, resistance to change, rivalry, ruthless ambition, Ringelmann social loafing, representativeness heuristic, Sadism, selective reporting, scheming for advancement, self-deception, self-interest, self-justification, self-preservation, self-promotion, scientific illiteracy, shame, sloth, slow wittedness, smug orthodoxy, social ambition, sociopathy, social belonging, status seeking, sheer stupidity, sunk cost fallacy, straw man fallacy, subjective validation, self serving, self validating bias, situation psychology, Terrorizing, Texas sharpshooter fallacy, thievery, timidity, toadying, trickery, tribalism, ‘truthiness’,
Unthinking acquiescence, unchecked error copying, uninformed certainty, underresearch, unconscious misperception, Vanity, venality, veneration, virus hunting, Witch hunting, wishful thinking, worship of authority, Youthful naivete, and Zeal in the service of the establishment and the status quo.
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