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African AIDS badly overblown, UN confesses

UN cuts 7 million from global total, new infections down 40%

A second retreat from overestimates forced by critics

But when will the other shoe drop – and the entire viral story be abandoned? Not soon

africanaidscoffin.gifWell, well. Finally the UN is going to admit this week just how badly it overestimated the statistics for African AIDS, and that the supposed pandemic has been slowing for a decade.

The latest estimates, due to be released publicly Wednesday, put the number of annual new HIV infections at 2.5 million, a cut of more than 40 percent from last year’s estimate, documents show. The worldwide total of people infected with HIV — estimated a year ago at nearly 40 million and rising — now will be reported as 33 million.

The news report, U.N. to Cut Estimate Of AIDS Epidemic:Population With Virus Overstated by Millions, is from Craig Timberg in tomorrow morning’s Washington Post, where the admirable reporter already identified the problem nearly two years ago in April 2006 in his story How AIDS in Africa Was Overstated: Reliance on Data From Urban Prenatal Clinics Skewed Early Projections.

He writes that critics exerted pressure which partly brought about this official retreat, which is suitably embarrassing to the UN and will no doubt soon be surrounded by rationalizing explanations in line with the imaginary competence of UN statisticians, described by Rian Malan in Rolling Stone in 2001 as sitting in the UNAIDS offices in Geneva inflating the stats for the whole of Africa based on a few natal clinic reports which didn’t even include males.

Who were they, these estimators? For the most part, they worked in Geneva for WHO or UNAIDS, using a computer simulator called Epimodel. Every year, all over Africa, blood would be taken from a small sample of pregnant women and screened for signs of HIV infection. The results would be programmed into Epimodel, which transmuted them into estimates. If so many women were infected, it followed that a similar proportion of their husbands and lovers must be infected, too. These numbers would be extrapolated out into the general population, enabling the computer modellers to arrive at seemingly precise tallies of the doomed, the dying and the orphans left behind.

Because Africa is disorganised and, in some parts, unknowable, we had little choice other than to accept these projections. (‘We’ always expect the worst of Africa anyway.) Reporting on Aids in Africa became a quest for anecdotes to support Geneva’s estimates, and the estimates grew ever more terrible: 9.6 million cumulative Aids deaths by 1997, rising to 17 million three years later.

This latest development is a stunning story given the inevitable effect on international AIDS funding that it threatens, ie to divert billions into much more sensible areas such as malaria, TB, and especially in Africa, malnutrition, which is the major wrecker of immune systems, which are very easily crippled by undernourishment.

The United Nations’ AIDS agency, known as UNAIDS and led by Belgian scientist Peter Piot since its founding in 1995, has been a major advocate for increasing spending to combat the epidemic. Over the past decade, global spending on AIDS has grown by a factor of 30, reaching as much as $10 billion a year.

No doubt the counter propaganda is already being worked on day and night in the offices of WHO and UNAIDS and in Washington where director Anthony Fauci is undoubtedly telling his pr staff at NIAID to burn the midnight oil and come up with an Op Ed piece for the New York Times by Wednesday, when the report is officially out for all the “denialists” to crow about.

With $15 billion from Congress allocated for the fight against the HIV=AIDS meme, and a share of billions more from Gates, the likelihood of a climbdown from the paradigm itself seems as high as the chances of a macaque leaping over Weill-Cornell Medical Center in a single bound.

Still, we added a comment to prod readers thoughts, at least, in this direction:

Comment added by scienceguardian 12.15 am Tuesday:

So what forced them to acknowledge this poor performance, which was covered in the Post in
February, and well before that in Rian Malan’s piece in Rolling Stone six years ago, denied by everybody at the time, of course?

And when will the other shoe drop? That the entire description of the world wide HIV=AIDS pandemic as caused by an infectious virus is null and void, a relabeling of other assaults on the immune system, disease and – especially in Africa – malnutrition, in terms of a scientific paradigm that was bankrupt when it was announced, and has proved to be so ever since, but as righteously defended against “denialists” as the African statistics have long been.

No vaccine, no cure, no healthy medication, no mechanism, no predictive power – the theory that HIV causes AIDS, ridiculed by the knowledgeable in the field when it was announced by Bob “I discovered HIV in the mail from Paris” Gallo 23 years ago, is the shame of science and the shame of reporters both knowing and gullible who have failed to tell the public how little science there is to support it. Kudos to Craig and his editors for running against the herd and doing a little investigation for a change.

But when will the Post break ranks and join Harpers magazine (April 2006) in exposing this entire disgrace for what it is – a corruption of far greater social consequence than the UN statisticians’ incompetence?

Then the $15 billion authorized for African disease, and the billions allocated by Gates, can be devoted to malaria, TB, the health infrastructure, food and other real problems in Africa, and not diverted into harmful and misapplied drugs irrelevant to the real needs of the continent.

U.N. to Cut Estimate Of AIDS Epidemic

U.N. to Cut Estimate Of AIDS Epidemic
Population With Virus Overstated by Millions

By Craig Timberg
Washington Post Foreign Service
Tuesday, November 20, 2007; A01

JOHANNESBURG, Nov. 19 — The United Nations’ top AIDS scientists plan to acknowledge this week that they have long overestimated both the size and the course of the epidemic, which they now believe has been slowing for nearly a decade, according to U.N. documents prepared for the announcement.

AIDS remains a devastating public health crisis in the most heavily affected areas of sub-Saharan Africa. But the far-reaching revisions amount to at least a partial acknowledgment of criticisms long leveled by outside researchers who disputed the U.N. portrayal of an ever-expanding global epidemic.

The latest estimates, due to be released publicly Wednesday, put the number of annual new HIV infections at 2.5 million, a cut of more than 40 percent from last year’s estimate, documents show. The worldwide total of people infected with HIV — estimated a year ago at nearly 40 million and rising — now will be reported as 33 million.

Having millions fewer people with a lethal contagious disease is good news. Some researchers, however, contend that persistent overestimates in the widely quoted U.N. reports have long skewed funding decisions and obscured potential lessons about how to slow the spread of HIV. Critics have also said that U.N. officials overstated the extent of the epidemic to help gather political and financial support for combating AIDS.

“There was a tendency toward alarmism, and that fit perhaps a certain fundraising agenda,” said Helen Epstein, author of “The Invisible Cure: Africa, the West, and the Fight Against AIDS.” “I hope these new numbers will help refocus the response in a more pragmatic way.”

Annemarie Hou, spokeswoman for the U.N. AIDS agency, speaking from Geneva, declined to comment on the grounds that the report will not be released publicly until Wednesday. In documents obtained by The Washington Post, U.N. officials say the revisions stemmed mainly from better measurements rather than fundamental shifts in the epidemic. They also say they are continually seeking to improve their tracking of AIDS with the latest available tools.

Among the reasons for the overestimate is methodology; U.N. officials traditionally based their national HIV estimates on infection rates among pregnant women receiving prenatal care. As a group, such women were younger, more urban, wealthier and likely to be more sexually active than populations as a whole, according to recent studies.

The United Nations’ AIDS agency, known as UNAIDS and led by Belgian scientist Peter Piot since its founding in 1995, has been a major advocate for increasing spending to combat the epidemic. Over the past decade, global spending on AIDS has grown by a factor of 30, reaching as much as $10 billion a year.

But in its role in tracking the spread of the epidemic and recommending strategies to combat it, UNAIDS has drawn criticism in recent years from Epstein and others who have accused it of being politicized and not scientifically rigorous.

For years, UNAIDS reports have portrayed an epidemic that threatened to burst beyond its epicenter in southern Africa to generate widespread illness and death in other countries. In China alone, one report warned, there would be 10 million infections — up from 1 million in 2002 — by the end of the decade.

Piot often wrote personal prefaces to those reports warning of the dangers of inaction, saying in 2006 that “the pandemic and its toll are outstripping the worst predictions.”

But by then, several years’ worth of newer, more accurate studies already offered substantial evidence that the agency’s tools for measuring and predicting the course of the epidemic were flawed.

Newer studies commissioned by governments and relying on random, census-style sampling techniques found consistently lower infection rates in dozens of countries. For example, the United Nations has cut its estimate of HIV cases in India by more than half because of a study completed this year. This week’s report also includes major cuts to U.N. estimates for Nigeria, Mozambique and Zimbabwe.

The revisions affect not just current numbers but past ones as well. A UNAIDS report from December 2002, for example, put the total number of HIV cases at 42 million. The real number at that time was 30 million, the new report says.

The downward revisions also affect estimated numbers of orphans, AIDS deaths and patients in need of costly antiretroviral drugs — all major factors in setting funding levels for the world’s response to the epidemic.

James Chin, a former World Health Organization AIDS expert who has long been critical of UNAIDS, said that even these revisions may not go far enough. He estimated the number of cases worldwide at 25 million.

“If they’re coming out with 33 million, they’re getting closer. It’s a little high, but it’s not outrageous anymore,” Chin, author of “The AIDS Pandemic: The Collision of Epidemiology With Political Correctness,” said from Berkeley, Calif.

The picture of the AIDS epidemic portrayed by the newer studies, and set to be endorsed by U.N. scientists Wednesday, shows a massive concentration of infections in the southern third of Africa, with nations such as Swaziland and Botswana reporting as many as one in four adults infected with HIV.

Rates are lower in East Africa and much lower in West Africa. Researchers say that the prevalence of circumcision, which slows the spread of HIV, and regional variations in sexual behavior are the biggest factors determining the severity of the AIDS epidemic in different countries and even within countries.

Beyond Africa, AIDS is more likely to be concentrated among high-risk groups, such as users of injectable drugs, sex workers and gay men. More precise measurements of infection rates should allow for better targeting of prevention measures, researchers say.

Comments on the piece so far (12.15am Tuesday November 19 2007) UPDATE November 22 4.19 pm a good insider one added this Thanksgiving morning, first quote:

screenwalker wrote:
Let’s look at the topic in general here to potentially provide a cui bono:

The M&E (monitoring and evaluation) issues with AIDS are in general not substantial different from other pandemics etc.
Given this and as it is possible to establish proper figures with e.g. pneumonia and all other epidemics or diseases where no large amounts of “funding” are involved or particular political targets are pursuit there must be other reasons.

Two examples (anecdotal):

1. When SARS first hit, China was even trying to adjust their population numbers to make them look smaller and downplay the issues (ask people at the WHO that were involved at that time)

2. How are figures collected / processed that later are reported regarding AIDS:

First (again anecdotal) the WHO a few years ago did an IT / IS fair for all areas they work in. Guess what – anywhere but with AIDS, Malaria and TB processes and supporting applications could be identified and were showcased. But particular with AIDS it became clear that “data collections” were on an individual “researcher” base captured and edited by individuals within this and other organizations in MS Excel spreadsheets only. Anybody who knows how to use MS Excel also might knows how “easily” numbers on collections that scale “might be lost” or “mistakingly” overwritten/edited. It’s just not the right tool for such an endeavor. The situation since then might have changed with some of the organizations involved.

Second, one of the organizations that receive the majority of fundings from the G8 for the “fight against AIDS” (billions of USD – dozens of times what UNAIDS receives) still – even internally – treats all detail data received from countries as “top secret” and makes it available even internally only after “massaging” the numbers. There is the story that about 2 years ago they were ordered to collect data in a systematic way. It took two weeks – with the support of some IT tools – to get the picture. After that about a hundred people “massaged” the numbers for more than 3 months until the numbers were in line with what was already reported before. They also have a “track record” of being a “computer free zone” to the extend that people that tried to bring in accountability have been fired and those that have (openly) sabotaged this got promoted or “palmed off”. Read – we do anything to block accountability or systematic approaches. The IT solutions that allowed the data collections earlier were almost immediately turned off. Instead piles of documents / paper are produced to cover up. If you look at the overall relationship here Government G8 (should follow accountability rules) – kind of NGO / Internationally coordinated organization (impression of accountability only) – Developing Country (accountability , well you decide up to 80% corruption in some) you might understand what this is all about.

If the money would arrive with those in need nothing would be wrong with that but unfortunately – as some of the most reputable people in the “trade” report – it does not.

Given all of this I believe pointing at people like P.Piot does not cut to the core of the issue. There is no single person – particular not the head of UNAIDS , responsible for that. The WHO and UNAIDS today only represent a minority share in the “money streams” within AIDS. Look at USAIDS, PEPFAR, DFID, TGF, UNDP…

P.S. There is a story going around in Geneva that one of the key players involved in the “fight against AIDS” blows more money in 2 months on “administrative tasks” than the WHO or UNAIDS have as a budget for 2 years.
The worst of all – this might be in line with a change of thinking that was last popular in the 1950s. Within this dreadful context the name Thomas Malthus returns to mind…
11/22/2007 12:10:33 AM

Previously cynical1 wrote:
As a former WHO employee, I can reinforce the thrust of the article that statistics are manipulated in an effort to obtain higher budgets. Many of the regional offices of WHO can not repeat not intelligently spend their budgets and create “Agreed Program of Work” to absorb the excess funds as the budget period comes to a close. The latest accounting/enterprise system which was approved with certain cost efficiencies as a requirement have not reulted in one position to be eliminated. The contrary is in fact the truth. WHO needs an immediate overhaul and the US Government should start looking harder at its participation in these agencies rather than blindly endorse corrupt practices and equally corrupt officials.

Your Comments On…
U.N. to Cut Estimate Of AIDS Epidemic
JOHANNESBURG, Nov. 19 — The United Nations’ top AIDS scientists plan to acknowledge this week that they have long overestimated both the size and the course of the epidemic, which they now believe has been slowing for nearly a decade, according to U.N. documents prepared for the announcement.

By Craig Timberg

Comments
msmithnv wrote:
This is very good news.

I think the controversial at first plain talking public education campaign launched in Africa is starting to work.

The theme, “The Rear is not a Gear.” seemed too bold at first but evidently broke through the consciousness of over exposed safe sex messages about condoms and spoke to the heart of the matter.

11/19/2007 11:38:44 PM
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ooyah32 wrote:
“Researchers say that the prevalence of circumcision, which slows the spread of HIV, and regional variations in sexual behavior are the biggest factors determining the severity of the AIDS epidemic in different countries and even within countries.”

What? WHAT??? Circumcision and sexual behavior are the biggest factors in limiting HIV/AIDS? How can this be? The elites have told us for years that only condoms are the answer, that condoms are the number one factor in limiting HIV/AIDS.
11/19/2007 11:34:51 PM
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ooyah32 wrote:
I am shocked — SHOCKED — that scientists would allow politics to color and dictate their scientific findings.
11/19/2007 11:30:14 PM
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krushX wrote:
Since when have prostitutes and hustlers, pimps and stars of pornographic movies been legitimized as “sex workers”? Isn’t the Post going a little far here in trying to sanitize the sleazy underbelly of society? The very term sounds stupid. Usually we use the term “laborers” rather than workers, as in field laborers and day laborer, so I guess this is sex labor?

Besides, high-risk groups for AIDS vary based on culture. In India it was India it was truck drivers who frequented prostitutes — or as the Post would have it sex workers.
11/19/2007 11:14:57 PM
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sales3 wrote:
For AIDS, $10bn globally, total = 1 month in Iraq

You guys are so pathetically callous and cheap, you squeak.
11/19/2007 9:45:37 PM
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erkola wrote:
To overstate numbers for political and financial support, by the U.N. no less, is hitting near the bottom. When you begin to undermine peoples’ charitable nature, a complete turning away from helping any charity, regardless of how desperate, is possible. Then what?
11/19/2007 8:41:55 PM
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shady02 wrote:
No surprise here. The UN is joke. They are doing the same thing now with all their global warming reports.
11/19/2007 8:04:21 PM
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cynical1 wrote:
As a former WHO employee, I can reinforce the thrust of the article that statistics are manipulated in an effort to obtain higher budgets. Many of the regional offices of WHO can not repeat not intelligently spend their budgets and create “Agreed Program of Work” to absorb the excess funds as the budget period comes to a close. The latest accounting/enterprise system which was approved with certain cost efficiencies as a requirement have not reulted in one position to be eliminated. The contrary is in fact the truth. WHO needs an immediate overhaul and the US Government should start looking harder at its participation in these agencies rather than blindly endorse corrupt practices and equally corrupt officials.
11/19/2007 8:00:20 PM
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bobmoses wrote:
“There was a tendency toward alarmism, and that fit perhaps a certain fundraising agenda.”

Sound like the UN’s position on global warming.
11/19/2007 7:34:50 PM
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amengeo wrote:
The UN misquoting of AIDS figures adds another few nails in the coffin of credibility of these public institutions which assail us with a constant barrage of alarmist ‘findings’ and ‘reports.’ The next time I read that the ‘international community [read the US, Western Europe, Canada and Australia’] believes the sky is going to fall, or that ‘millions will die in Darfur or that we need to ‘rush rice to starving children in Kenya and your $10 will help,’ I going out to get the shovel. Is it any wonder that with these credibility gaps from governments, agencies, religious figures and Presidents that most people distrust those in authority? Weapons of Mass deception, anyone?
11/19/2007 7:24:13 PM
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12thgenamerican wrote:
just slide global warming in where it says aids and you will have a future headline.
11/19/2007 6:52:38 PM
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gitarre wrote:
“There was a tendency toward alarmism, and that fit perhaps a certain fundraising agenda.”

What a genteel turn of phrase. Save that quote for the similar article, coming within a year or two, on “Global Warming” …
.
11/19/2007 6:35:28 PM

The massive death toll from AIDS in Africa has not materialized. There is no country today that has a population smaller than it was 5 years or 10 years or 20 years ago. In fact, what is not pointed out in the article, is that for instance the population of Uganda doubled between 1980 and 2000, from 12 million to 24 million. In 2005, it stood at 28 million. So why do we put any stock in predictions made for Southern Africa, when the figures and predictions for West, East and Central Africa were completely off base? Source: US Census Bureau,

We added a comment

Comment added by scienceguardian 12.15 am Tuesday:

So what forced them to acknowledge this poor performance, which was covered in the Post in
February, and well before that in Rian Malan’s piece in Rolling Stone six years ago, denied by everybody at the time, of course?

And when will the other shoe drop? That the entire description of the world wide HIV=AIDS pandemic as caused by an infectious virus is null and void, a relabeling of other assaults on the immune system, disease and – especially in Africa – malnutrition, in terms of a scientific paradigm that was bankrupt when it was announced, and has proved to be so ever since, but as righteously defended against “denialists” as the African statistics have long been.

No vaccine, no cure, no healthy medication, no mechanism, no predictive power – the theory that HIV causes AIDS, ridiculed by the knowledgeable in the field when it was announced by Bob “I discovered HIV in the mail from Paris” Gallo 23 years ago, is the shame of science and the shame of reporters both knowing and gullible who have failed to tell the public how little science there is to support it. Kudos to Craig and his editors for running against the herd and doing a little investigation for a change.

But when will the Post break ranks and join Harpers magazine (April 2006) in exposing this entire disgrace for what it is – a corruption of far greater social consequence than the UN statisticians’ incompetence?

Then the $15 billion authorized for African disease, and the billions allocated by Gates, can be devoted to malaria, TB, the health infrastructure, food and other real problems in Africa, and not diverted into harmful and misapplied drugs irrelevant to the real needs of the continent.

Here is the earlier story in the Washington Post by Craig Timberg April 6 2006, Previous story on HIV exaggerated estimates in Africa in Washington Post: How AIDS in Africa Was Overstated: Reliance on Data From Urban Prenatal Clinics Skewed Early Projections:

Rwanda, a mountainous country of about 8.5 million people jammed into a land area smaller than Maryland, has relied on approaches similar to those used in Uganda, and may have produced similar declines in HIV. UNAIDS estimated in 1998 that 370,000 Rwandans were infected, equal to 12.75 percent of all working-age adults and a substantial percentage of children as well. Every two years since, the agency has lowered that estimate — to 11.2 percent in 2000, 8.9 percent in 2002 and 5.1 percent in 2004.

Dirk van Hove, the top UNAIDS official in Rwanda, said the next official estimate, due in May, would show an infection rate of “about 3 percent,” in line with the new national study. He said the U.N. estimate tracked the declining prevalence.

Rwandan health officials say their national HIV infection rate might once have topped 3 percent and then declined. But it’s just as likely, they say, that these apparent trends reflected nothing more than flawed studies.

Correction to This Article
An April 6 article and an accompanying graphic said the HIV rate among people in Botswana ages 15 to 49 was 34.9 percent. More recent information shows the rate to be 25.3 percent. The faulty statistic from the article was also used in an April 10 editorial.
How AIDS in Africa Was Overstated
Reliance on Data From Urban Prenatal Clinics Skewed Early Projections

By Craig Timberg
Washington Post Foreign Service
Thursday, April 6, 2006; A01

KIGALI, Rwanda — Researchers said nearly two decades ago that this tiny country was part of an AIDS Belt stretching across the midsection of Africa, a place so infected with a new, incurable disease that, in the hardest-hit places, one in three working-age adults were already doomed to die of it.

But AIDS deaths on the predicted scale never arrived here, government health officials say. A new national study illustrates why: The rate of HIV infection among Rwandans ages 15 to 49 is 3 percent, according to the study, enough to qualify as a major health problem but not nearly the national catastrophe once predicted.

The new data suggest the rate never reached the 30 percent estimated by some early researchers, nor the nearly 13 percent given by the United Nations in 1998.

The study and similar ones in 15 other countries have shed new light on the disease across Africa. Relying on the latest measurement tools, they portray an epidemic that is more female and more urban than previously believed, one that has begun to ebb in much of East Africa and has failed to take off as predicted in most of West Africa.

Yet the disease is devastating southern Africa, according to the data. It is in that region alone — in countries including South Africa, Botswana, Swaziland and Zimbabwe — that an AIDS Belt exists, the researchers say.

“What we know now more than ever is southern Africa is the absolute epicenter,” said David Wilson, a senior AIDS analyst for the World Bank, speaking from Washington.

In the West African country of Ghana, for example, the overall infection rate for people ages 15 to 49 is 2.2 percent. But in Botswana, the national infection rate among the same age group is 34.9 percent. And in the city of Francistown, 45 percent of men and 69 percent of women ages 30 to 34 are infected with HIV, the virus that causes AIDS.

Most of the studies were conducted by ORC Macro, a research corporation based in Calverton, Md., and were funded by the U.S. Agency for International Development, other international donors and various national governments in the countries where the studies took place.

Taken together, they raise questions about monitoring by the U.N. AIDS agency, which for years overestimated the extent of HIV/AIDS in East and West Africa and, by a smaller margin, in southern Africa, according to independent researchers and U.N. officials.

“What we had before, we cannot trust it,” said Agnes Binagwaho, a senior Rwandan health official.

Years of HIV overestimates, researchers say, flowed from the long-held assumption that the extent of infection among pregnant women who attended prenatal clinics provided a rough proxy for the rate among all working-age adults in a country. Working age was usually defined as 15 to 49. These rates also were among the only nationwide data available for many years, especially in Africa, where health tracking was generally rudimentary.

The new studies show, however, that these earlier estimates were skewed in favor of young, sexually active women in the urban areas that had prenatal clinics. Researchers now know that the HIV rate among these women tends to be higher than among the general population.

The new studies rely on random testing conducted across entire countries, rather than just among pregnant women, and they generally require two forms of blood testing to guard against the numerous false positive results that inflated early estimates of the disease. These studies also are far more effective at measuring the often dramatic variations in infection rates between rural and urban people and between men and women.

UNAIDS, the agency headed since its creation in 1995 by Peter Piot, a Belgian physician, produced its first global snapshot of the disease in 1998. Each year since, the United Nations has issued increasingly dire assessments: UNAIDS estimated that 36 million people around the world were infected in 2000, including 25 million in Africa. In 2002, the numbers were 42 million globally, with 29 million in Africa.

But by 2002, disparities were already emerging. A national study in the southern African country of Zambia, for example, found a rate of 15.6 percent, significantly lower than the U.N. rate of 21.5 percent. In Burundi, which borders Rwanda in central East Africa, a national study found a rate of 5.4 percent, not the 8.3 percent estimated by UNAIDS.

In West Africa, Sierra Leone, just then emerging from a devastating civil war, was found to have a national prevalence rate of less than 1 percent — compared with an estimated U.N. rate of 7 percent.

Such disparities, independent researchers say, skewed years of policy judgments and decisions on where to spend precious health-care dollars.

“From a research point of view, they’ve done a pathetic job,” said Paul Bennell, a British economist whose studies of the impact of AIDS on African school systems have shown mortality far below what UNAIDS had predicted. “They were not predisposed, let’s put it that way, to weigh the counterevidence. They were looking to generate big bucks.”

The United Nations started to revise its estimates in light of the new studies in its 2004 report, reducing the number of infections in Africa by 4.4 million, back to the total four years earlier of 25 million. It also gradually decreased the overall infection rate for working-age adults in sub-Saharan Africa, from 9 percent in a 2002 report to 7.2 percent in its latest report, released in November.

Peter Ghys, an epidemiologist who has worked for UNAIDS since 1999, acknowledged in an interview from his office in Geneva that HIV projections several years ago were too high because they relied on data from prenatal clinics.

But Ghys said the agency made the best estimates possible with the information available. As better data emerged, such as the new wave of national population studies, it has made revisions where necessary, he said.

“What has happened is we have come to realize that indeed we have overestimated the epidemic a bit,” he said.

On its Web site, UNAIDS describes itself as “the chief advocate for worldwide action against AIDS.” And many researchers say the United Nations’ reliance on rigorous science waned after it created the separate AIDS agency in 1995 — the first time the world body had taken this approach to tackle a single disease.

In the place of previous estimates provided by the World Health Organization, outside researchers say, the AIDS agency produced reports that increasingly were subject to political calculations, with the emphasis on raising awareness and money.

“It’s pure advocacy, really,” said Jim Chin, a former U.N. official who made some of the first global HIV prevalence estimates while working for WHO in the late 1980s and early 1990s. “Once you get a high number, it’s really hard once the data comes in to say, ‘Whoops! It’s not 100,000. It’s 60,000.’ ”

Chin, speaking from Stockton, Calif., added, “They keep cranking out numbers that, when I look at them, you can’t defend them.”

Ghys said he never sensed pressure to inflate HIV estimates. “I can’t imagine why UNAIDS or WHO would want to do that,” he said. “If we did that, it would just affect our credibility.”

Ghys added that studies now show that the overall percentage of Africans with HIV has stabilized, though U.N. models still show increasing numbers of people with the virus because of burgeoning populations.

Many other researchers, including Wilson from the World Bank and two epidemiologists from the U.S. Agency for International Development who wrote a study published last week in the Lancet, a British medical journal, dispute that conclusion, saying that the number of new cases in Africa peaked several years ago.

Some involved in the fight against AIDS say that tallying HIV cases is not nearly as important as finding the resources to fight the disease. That is especially true now that antiretroviral drugs are more affordable, making it possible to extend millions of lives if enough money and health-care workers are available to facilitate treatment.

“It doesn’t matter how long the line is if you never get to the end of it,” said Francois Venter, a South African doctor and head of Johannesburg General Hospital’s rapidly expanding antiretroviral drug program, speaking in an interview in Johannesburg.

But to the researchers who drive AIDS policy, differences in infection rates are not merely academic. They scour the world looking for evidence of interventions that have worked, such as the rigorous enforcement of condom use at brothels in Thailand and aggressive public campaigns that have urged Ugandans to limit their sexual partners to one.

Programs deemed successful are urged on other countries and funded lavishly by international donors, often to the exclusion of other programs.

Rwanda, a mountainous country of about 8.5 million people jammed into a land area smaller than Maryland, has relied on approaches similar to those used in Uganda, and may have produced similar declines in HIV. UNAIDS estimated in 1998 that 370,000 Rwandans were infected, equal to 12.75 percent of all working-age adults and a substantial percentage of children as well. Every two years since, the agency has lowered that estimate — to 11.2 percent in 2000, 8.9 percent in 2002 and 5.1 percent in 2004.

Dirk van Hove, the top UNAIDS official in Rwanda, said the next official estimate, due in May, would show an infection rate of “about 3 percent,” in line with the new national study. He said the U.N. estimate tracked the declining prevalence.

Rwandan health officials say their national HIV infection rate might once have topped 3 percent and then declined. But it’s just as likely, they say, that these apparent trends reflected nothing more than flawed studies.

Even so, Rwanda’s cities show signs of a serious AIDS problem not yet tamed. The new study found that 8.6 percent of urban, working-age women have HIV. Overall, officials say, 150,000 Rwandans are infected, less than half the number estimated by UNAIDS in 1998.

Bruno Ngirabatware, a physician who has treated AIDS patients in Kigali since the 1980s, said he has seen no evidence of a recent decline in HIV infection rates.

“There’s lots of patients there, always,” he said.

Here are the Comments posted on the earlier article, How AIDS in Africa Was Overstated:

This article is an excellent start to rewriting the history of AIDS in Africa and the horrific — and phony — statistics that have been used for too long to tell entire populations of Africans that they are doomed to die from AIDS and nothing except maybe billions of dollars worth of expensive, toxic antiviral drugs can save them. It doesnt go far enough, though. It doesnt mention that the terrifying estimates of HIV seroprevalence in South Africa were made by the same invalid technique — extrapolating from a handful of tests on pregnant women to an entire population — as the ones in Rwanda, Ghana, Sierra Leone and the other countries mentioned in the article. It also doesnt discuss the fact that pregnancy itself is known to cause false-positives on the standard HIV antibody tests — or that the more often a woman has been pregnant before, the more likely a new test is to be false-positive and women in Africa and other parts of the developing world tend to get pregnant more often than those in developed countries, partly because they have to in order to reproduce their populations in the face of high infant mortality and partly because of lack of access to birth control….

The massive death toll from AIDS in Africa has not materialized. There is no country today that has a population smaller than it was 5 years or 10 years or 20 years ago. In fact, what is not pointed out in the article, is that for instance the population of Uganda doubled between 1980 and 2000, from 12 million to 24 million. In 2005, it stood at 28 million. So why do we put any stock in predictions made for Southern Africa, when the figures and predictions for West, East and Central Africa were completely off base? Source: US Census Bureau….


Your Comments On…
How AIDS in Africa Was Overstated
KIGALI, Rwanda — Researchers said nearly two decades ago that this tiny country was part of an AIDS Belt stretching across the midsection of Africa, a place so infected with a new, incurable disease that, in the hardest-hit places, one in three working-age adults were already doomed to die of it.
– By Craig Timberg
Comments

If rich European nations and other better off countries would invest more in the stop of ait and modernization of the parts that are still so called uncivilized I think the aids spread rate would drop significantly.

By killerdan56 | Jul 19, 2006 3:22:33 PM | Request Removal

This article is an excellent start to rewriting the history of AIDS in Africa and the horrific — and phony — statistics that have been used for too long to tell entire populations of Africans that they are doomed to die from AIDS and nothing except maybe billions of dollars worth of expensive, toxic antiviral drugs can save them. It doesnt go far enough, though. It doesnt mention that the terrifying estimates of HIV seroprevalence in South Africa were made by the same invalid technique — extrapolating from a handful of tests on pregnant women to an entire population — as the ones in Rwanda, Ghana, Sierra Leone and the other countries mentioned in the article. It also doesnt discuss the fact that pregnancy itself is known to cause false-positives on the standard HIV antibody tests — or that the more often a woman has been pregnant before, the more likely a new test is to be false-positive and women in Africa and other parts of the developing world tend to get pregnant more often than those in developed countries, partly because they have to in order to reproduce their populations in the face of high infant mortality and partly because of lack of access to birth control.

By mgconlan | Aug 6, 2006 6:17:03 PM | Request Removal

The massive death toll from AIDS in Africa has not materialized. There is no country today that has a population smaller than it was 5 years or 10 years or 20 years ago. In fact, what is not pointed out in the article, is that for instance the population of Uganda doubled between 1980 and 2000, from 12 million to 24 million. In 2005, it stood at 28 million. So why do we put any stock in predictions made for Southern Africa, when the figures and predictions for West, East and Central Africa were completely off base? Source: US Census Bureau,

By avdeelen | Feb 24, 2007 9:14:39 AM | Request Removal

Here is the article by Rian Malan in Rolling Stone Magazine, November 22, 2001, AIDS in Africa: In Search of the Truth, by Rian Malan:

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.

Rolling Stone Magazine, November 22, 2001

AIDS in Africa

In Search of the Truth

by Rian Malan

See graphics one and two for title illustration by Mark Ulriksen

Dear Jann,

You will be saddened to hear that Adelaide Ntsele has died. As you may recall, she featured briefly in my article a year ago about the long, twisted history of the song, “The Lion Sleeps Tonight,” which was based on a melody composed by her father, Solomon Linda. While I interviewed her sisters about the life and times of their father, the great Zulu singer, Adelaide was swooning feverishly under greasy blankets. She got up from her sickbed only to have her picture taken. She was so weak she could barely stand, but she wanted to be in your magazine.

I took her to hospital afterward. We sat in Emergency for a long time, waiting for attention. Her sister Elizabeth was there, too. She’s a nurse. She looked at Adelaide’s hospital card and grew very quiet. Later, she told me there was a symbol indicating that Adelaide had come up positive on an HIV test. Atop that she had tuberculosis and a gynecological condition that required surgery. The operation had already been postponed repeatedly. To Elizabeth, it looked like the the doctors had decided, “Well, this one’s had it, she’ll die anyway, just let it happen.” And so it did.

A year ago, the funeral scene would have written itself. I would have described the kindly old pastor, the sad African singing, the giant iron pots on fires for the ritual goodbye feast. I would have mentioned the eerie absence of any reference to AIDS in the eulogies and made some rote observation about the denial it betokened. I would have scanned the faces of mourners, trying to pick out the one in five who were carriers of the virus that put Adelaide in her coffin, withered and shriveled like a child. And in the end I would have turned sadly away, lamenting a society that allowed a thirty-seven-year-old woman to die because she couldn’t afford the drugs available to rich white people.

Instead, I spent the ceremony thinking about viral antigens, cross-reactions and other mysteries of what Sowetans call H.I.Vilakazi, the scourge of the deadly three letters. Then, midway through the proceedings, the pastor broke my reverie; Perhaps the visitors would like to say something? I rose to my feet, straightened my tie and prepared to speak my mind, but courage failed me, so I mumbled a few platitudes instead. “It is a heartbreak that Adelaide was taken so young,” I said. “She bore terrible suffering with enormous dignity,” I said. “We will always remember her as she appears in that picture,” I concluded, nodding toward a framed portrait of a wistful young woman with huge doe eyes and haunting cheekbones like Marlene Dietrich’s. Adelaide wanted to be a model. She never made it. I extended my condolences to the family and sat down again.

It wasn’t the eulogy Adelaide deserved, but then it wasn’t the right time or place for a great cry of rage and confusion, either. But now the mourning is done, and there are things that must be said.

photo of Adelaide Ntsele her friends at funeral

1.

MY FIRST MISTAKE

Africa’s era of megadeath dawned in the fall of 1983, when the chief of internal medicine of a hospital in what was then Zaire sent a communique 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 grantmaking 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 Programme 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 couch 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.

photo of coffins

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 prophesy 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 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 th 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 or 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 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 evalutates 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 has 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: planeloads 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 diums 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.

photo of activists in Africa (note ACT-UP stickers on their shirts)

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 collegues 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 pregnancy 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 no 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. Feel free to publish this, Jann, but if it drives you as mad as it has driven me, I’ll understand.

Yours,

Malan

Here is Rian Malan in the Spectator, UK Dec 13 2003 (carried by LewRockwell.com): Africa isn’t dying of Aids: The headline figures are horrible: almost 30 million Africans have HIV/Aids. But, says Rian Malan, the figures are computer-generated estimates and they appear grotesquely exaggerated when set against population statistics:

With such thoughts in the back of my mind, South Africa’s Aids Day ‘celebrations’ cast me into a deeply leprous mood. Please don’t get me wrong here. I believe that Aids is a real problem in Africa. Governments and sober medical professionals should be heeded when they express deep concerns about it. But there are breeds of Aids activist and Aids journalist who sound hysterical to me. On Aids Day, they came forth like loonies drawn by a full moon, chanting that Aids was getting worse and worse, ‘spinning out of control’, crippling economies, causing famines, killing millions, contributing to the oppression of women, and ‘undermining democracy’ by sapping the will of the poor to resist dictators.

To hear them talk, Aids is the only problem in Africa, and the only solution is to continue the agitprop until free access to Aids drugs is defined as a ‘basic human right’ for everyone. They are saying, in effect, that because Mr Mhlangu of rural Zambia has a disease they find more compelling than any other, someone must spend upwards of $400 a year to provide Mr Mhlangu with life-extending Aids medication — a noble idea, on its face, but completely demented when you consider that Mr Mhlangu’s neighbours are likely to be dying in much larger numbers of diseases that could be cured for a few cents if medicines were only available. About 350 million Africans — nearly half the population — get malaria every year, but malaria medication is not a basic human right. Two million get TB, but last time I checked, spending on Aids research exceeded spending on TB by a crushing factor of 90 to one. As for pneumonia, cancer, dysentery or diabetes, let them take aspirin, or grub in the bush for medicinal herbs.

Cape Town

It was the eve of Aids Day here. Rock stars like Bono and Bob Geldof were jetting in for a fundraising concert with Nelson Mandela, and the airwaves were full of dark talk about megadeath and the armies of feral orphans who would surely ransack South Africa’s cities in 2017 unless funds were made available to take care of them. My neighbour came up the garden path with a press cutting. ‘Read this,’ said Capt. David Price, ex-Royal Air Force flyboy. ‘Bloody awful.’

It was an article from The Spectator describing the bizarre sex practices that contribute to HIV’s rampage across the continent. ‘One in five of us here in Zambia is HIV positive,’ said the report. ‘In 1993 our neighbour Botswana had an estimated population of 1.4 million. Today that figure is under a million and heading downwards. Doom merchants predict that Botswana may soon become the first nation in modern times literally to die out. This is Aids in Africa.’

Really? Botswana has just concluded a census that shows population growing at about 2.7 per cent a year, in spite of what is usually described as the worst Aids problem on the planet. Total population has risen to 1.7 million in just a decade. If anything, Botswana is experiencing a minor population explosion.

There is similar bad news for the doomsayers in Tanzania’s new census, which shows population growing at 2.9 per cent a year. Professional pessimists will be particularly discomforted by developments in the swamplands west of Lake Victoria, where HIV first emerged, and where the depopulated villages of popular mythology are supposedly located. Here, in the district of Kagera, population grew at 2.7 per cent a year before 1988, only to accelerate to 3.1 per cent even as the Aids epidemic was supposedly peaking. Uganda’s latest census tells a broadly similar story, as does South Africa’s.

Some might think it good news that the impact of Aids is less devastating than most laymen imagine, but they are wrong. In Africa, the only good news about Aids is bad news, and anyone who tells you otherwise is branded a moral leper, bent on sowing confusion and derailing 100,000 worthy fundraising drives. I know this, because several years ago I acquired what was generally regarded as a leprous obsession with the dumbfounding Aids numbers in my daily papers. They told me that Aids had claimed 250,000 South African lives in 1999, and I kept saying, this can’t possibly be true. What followed was very ugly — ruined dinner parties, broken friendships, ridicule from those who knew better, bitter fights with my wife. After a year or so, she put her foot down. Choose, she said. Aids or me. So I dropped the subject, put my papers in the garage, and kept my mouth shut.

As I write, madam is standing behind me with hands on hips, hugely irked by this reversion to bad habits. But looking around, it seems to me that Aids fever is nearing the danger level, and that some calming thoughts are called for. Bear with me while I explain.

We all know, thanks to Mark Twain, that statistics are often the lowest form of lie, but when it comes to HIV/Aids, we suspend all scepticism. Why? Aids is the most political disease ever. We have been fighting about it since the day it was identified. The key battleground is public perception, and the most deadly weapon is the estimate. When the virus first emerged, I was living in America, where HIV incidence was estimated to be doubling every year or so. Every time I turned on the TV, Madonna popped up to warn me that ‘Aids is an equal-opportunity killer’, poised to break out of the drug and gay subcultures and slaughter heterosexuals. In 1985, a science journal estimated that 1.7 million Americans were already infected, with ‘three to five million’ soon likely to follow suit. Oprah Winfrey told the nation that by 1990 ‘one in five heterosexuals will be dead of Aids’.

We now know that these estimates were vastly and indeed deliberately exaggerated, but they achieved the desired end: Aids was catapulted to the top of the West’s spending agenda, and the estimators turned their attention elsewhere. India’s epidemic was likened to ‘a volcano waiting to explode’. Africa faced ‘a tidal wave of death’. By 1992 they were estimating that ‘Aids could clear the whole planet’.

Who were they, these estimators? For the most part, they worked in Geneva for WHO or UNAIDS, using a computer simulator called Epimodel. Every year, all over Africa, blood would be taken from a small sample of pregnant women and screened for signs of HIV infection. The results would be programmed into Epimodel, which transmuted them into estimates. If so many women were infected, it followed that a similar proportion of their husbands and lovers must be infected, too. These numbers would be extrapolated out into the general population, enabling the computer modellers to arrive at seemingly precise tallies of the doomed, the dying and the orphans left behind.

Because Africa is disorganised and, in some parts, unknowable, we had little choice other than to accept these projections. (‘We’ always expect the worst of Africa anyway.) Reporting on Aids in Africa became a quest for anecdotes to support Geneva’s estimates, and the estimates grew ever more terrible: 9.6 million cumulative Aids deaths by 1997, rising to 17 million three years later.

Or so we were told. When I visited the worst affected parts of Tanzania and Uganda in 2001, I was overwhelmed with stories about the horrors of what locals called ‘Slims’, but statistical corroboration was hard to come by. According to government census bureaux, death rates in these areas had been in decline since the second world war. Aids-era mortality studies yielded some of the lowest overall death rates ever measured. Populations seemed to have exploded even as the epidemic was peaking.

Ask Aids experts about this, and they say, this is Africa, chaos reigns, the historical data is too uncertain to make valid comparisons. But these same experts will tell you that South Africa is vastly different: ‘The only country in sub-Saharan Africa where sufficient deaths are routinely registered to attempt to produce national estimates of mortality,’ says Professor Ian Timaeus of the London School of Hygiene and Tropical Medicine. According to Timaeus, upwards of 80 per cent of deaths are registered here, which makes us unique: the only corner of Africa where it is possible to judge computer-generated Aids estimates against objective reality.

In the year 2000, Timaeus joined a team of South African researchers bent on eliminating all doubts about the magnitude of Aids’ impact on South African mortality. Sponsored by the Medical Research Council, the team’s mission was to validate (for the first time ever) the output of Aids computer models against actual death registration in an African setting. Towards this end, the MRC team was granted privileged access to death reports as they streamed into Pretoria. The first results became available in 2001, and they ran thus: 339,000 adult deaths in 1998, 375,000 in 1999 and 410,000 in 2000.

This was grimly consistent with predictions of rising mortality, but the scale was problematic. Epimodel estimated 250,000 Aids deaths in 1999, but there were only 375,000 adult deaths in total that year — far too few to accommodate the UN’s claims on behalf of the HIV virus. In short, Epimodel had failed its reality check. It was quietly shelved in favour of a more sophisticated local model, ASSA 600, which yielded a ‘more realistic’ death toll from Aids of 143,000 for the calendar year 1999.

At this level, Aids deaths were about 40 per cent of the total — still a bit high, considering there were only 232,000 deaths left to distribute among all other causes. The MRC team solved the problem by stating that deaths from ordinary disease had declined at the cumulatively massive rate of nearly 3 per cent per annum since 1985. This seemed very odd. How could deaths decrease in the face of new cholera and malaria epidemics, mounting poverty, the widespread emergence of drug-resistant killer microbes, and a state health system reported to be in ‘terminal decline’?

But anyway, these researchers were experts, and their tinkering achieved the desired end: modelled Aids deaths and real deaths were reconciled, the books balanced, truth revealed. The fruit of the MRC’s ground-breaking labour was published in June 2001, and my hash appeared to have been settled. To be sure, I carped about curious adjustments and overall magnitude, but fell silent in the face of graphs showing huge changes in the pattern of death, with more and more people dying at sexually active ages. ‘How can you argue with this?’ cried my wife, eyes flashing angrily. I couldn’t. I put my Aids papers in the garage and ate my hat.

But I couldn’t help sneaking the odd look at science websites to see how the drama was developing. Towards the end of 2001, the vaunted ASSA 600 model was replaced by ASSA 2000, which produced estimates even lower than its predecessor: for the calendar year 1999, only 92,000 Aids deaths in total. This was just more than a third of the original UN figure, but no matter; the boffins claimed ASSA 2000 was so accurate that further reference to actual death reports ‘will be of limited usefulness’. A bit eerie, I thought, being told that virtual reality was about to render the real thing superfluous, but if these experts said the new model was infallible, it surely was infallible.

Only it wasn’t. Last December ASSA 2000 was retired, too. A note on the MRC website explained that modelling was an inexact science, and that ‘the number of people dying of Aids has only now started to increase’. Furthermore, said the MRC, there was a new model in the works, one that would ‘probably’ produce estimates ‘about 10 per cent lower’ than those presently on the table. The exercise was not strictly valid, but I persuaded my scientist pal Rodney Richards to run the revised data on his own simulator and see what he came up with for 1999. The answer, very crudely, was an Aids death toll somewhere around 65,000 — a far cry indeed from the 250,000 initially put forth by UNAIDS.

The wife has just read this, and she is not impressed. ‘It’s obscene,’ she says. ‘You’re treating this as if it’s just a computer game. People are dying out there.’

Well, yes. I concede that. People are dying, but this doesn’t spare us from the fact that Aids in Africa is indeed something of a computer game. When you read that 29.4 million Africans are ‘living with HIV/Aids’, it doesn’t mean that millions of living people have been tested. It means that modellers assume that 29.4 million Africans are linked via enormously complicated mathematical and sexual networks to one of those women who tested HIV positive in those annual pregnancy-clinic surveys. Modellers are the first to admit that this exercise is subject to uncertainties and large margins of error. Larger than expected, in some cases.

A year or so back, modellers produced estimates that portrayed South African universities as crucibles of rampant HIV infection, with one in four undergraduates doomed to die within ten years. Prevalence shifted according to racial composition and region, with Kwazulu-Natal institutions worst affected and Rand Afrikaans University (still 70 per cent white) coming in at 9.5 per cent. Real-life tests on a random sample of 1,188 RAU students rendered a startlingly different conclusion: on-campus prevalence was 1.1 per cent, barely a ninth of the modelled figure. ‘Doubt is cast on present estimates,’ said the RAU report, ‘and further research is strongly advocated.’

A similar anomaly emerged when South Africa’s major banks ran HIV tests on 29,000 staff earlier this year. A modelling exercise put HIV prevalence as high as 12 per cent; real-life tests produced a figure closer to 3 per cent. Elsewhere, actuaries are scratching their heads over a puzzling lack of interest in programs set up by medical-insurance companies to handle an anticipated flood of middle-class HIV cases. Old Mutual, the insurance giant, estimates that as many as 570,000 people are eligible, but only 22,500 have thus far signed up.

In Grahamstown, district surgeon Dr Stuart Dyer is contemplating an equally perplexing dearth of HIV cases in the local jail. ‘Sexually transmitted diseases are common in the prison where I work,’ he wrote to the Lancet, ‘and all prisoners who have any such disease are tested for HIV. Prisoners with any other illnesses that do not resolve rapidly (within one to two weeks) are also tested for HIV. As a result, a large number of HIV tests are done every week. This prison, which holds 550 inmates and is always full or overfull, has an HIV infection rate of 2 to 4 per cent and has had only two deaths from Aids in the seven years I have been working there.’ Dyer goes on to express a dim view of statistics that give the impression that ‘the whole of South Africa will be depopulated within 24 months’, and concludes by stating, ‘HIV infection in SA prisons is currently 2.3 per cent.’ According to the newspapers, it should be closer to 60 per cent.

On the face of it, these developments suggest that miracles are happening in South Africa, unreported by anyone save a brave little magazine called Noseweek. If the anomalies described above are typical, computer models are seriously overstating HIV prevalence. A similar picture emerges on the national level, where our estimated annual Aids death toll has halved since we eased UNAIDS out of the picture, with further reductions likely when the new MRC model appears. Could the same thing be happening in the rest of Africa?

Most estimates for countries north of the Limpopo are issued by UNAIDS, using methods similar to those discredited here in South Africa. According to Paul Bennell, a health- policy analyst associated with Sussex University’s Institute for Development Studies, there is an ‘extraordinary’ lack of evidence from other sources. ‘Most countries do not even collect data on deaths,’ he writes. ‘There is virtually no population-based survey data in most high-prevalence countries.’

Bennell was able, however, to gather information about Africa’s schoolteachers, usually described as a high-risk HIV group on account of their steady income, which enables them to drink and party more than others. Last year the World Bank claimed that Aids was killing Africa’s teachers ‘faster than they can be replaced’. The BBC reported that ‘one in seven’ Malawian teachers would die in 2002 alone.

Bennell looked at the available evidence and found actual teacher mortality to be ‘much lower than expected’. In Malawi, for instance, the all-causes death rate among schoolteachers was under 3 per cent, not over 14 per cent. In Botswana, it was about three times lower than computer-generated estimates. In Zimbabwe, it was four times lower. Bennell believes that Aids continues to present a serious threat to educators, but concludes that ‘overall impact will not be as catastrophic as suggested’. What’s more, teacher deaths appear to be declining in six of the eight countries he has studied closely. ‘This is quite unexpected,’ he remarks, ‘and suggests that, in terms of teacher deaths, the worst may be over.’

In the past year or so, similar mutterings have been heard throughout southern Africa — the epidemic is levelling off or even declining in the worst-affected countries. UNAIDS has been at great pains to rebut such ideas, describing them as ‘dangerous myths’, even though the data on UNAIDS’ own website shows they are nothing of the sort. ‘The epidemic is not growing in most countries,’ insists Bennell. ‘HIV prevalence is not increasing as is usually stated or implied.’

Bennell raises an interesting point here. Why would UNAIDS and its massive alliance of pharmaceutical companies, NGOs, scientists and charities insist that the epidemic is worsening if it isn’t? A possible explanation comes from New York physician Joe Sonnabend, one of the pioneers of Aids research. Sonnabend was working in a New York clap clinic when the syndrome first appeared, and went on to found the American Foundation for Aids Research, only to quit in protest when colleagues started exaggerating the threat of a generalised pandemic with a view to increasing Aids’ visibility and adding urgency to their grant applications. The Aids establishment, says Sonnabend, is extremely skilled at ‘the manipulation of fear for advancement in terms of money and power’.

With such thoughts in the back of my mind, South Africa’s Aids Day ‘celebrations’ cast me into a deeply leprous mood. Please don’t get me wrong here. I believe that Aids is a real problem in Africa. Governments and sober medical professionals should be heeded when they express deep concerns about it. But there are breeds of Aids activist and Aids journalist who sound hysterical to me. On Aids Day, they came forth like loonies drawn by a full moon, chanting that Aids was getting worse and worse, ‘spinning out of control’, crippling economies, causing famines, killing millions, contributing to the oppression of women, and ‘undermining democracy’ by sapping the will of the poor to resist dictators.

To hear them talk, Aids is the only problem in Africa, and the only solution is to continue the agitprop until free access to Aids drugs is defined as a ‘basic human right’ for everyone. They are saying, in effect, that because Mr Mhlangu of rural Zambia has a disease they find more compelling than any other, someone must spend upwards of $400 a year to provide Mr Mhlangu with life-extending Aids medication — a noble idea, on its face, but completely demented when you consider that Mr Mhlangu’s neighbours are likely to be dying in much larger numbers of diseases that could be cured for a few cents if medicines were only available. About 350 million Africans — nearly half the population — get malaria every year, but malaria medication is not a basic human right. Two million get TB, but last time I checked, spending on Aids research exceeded spending on TB by a crushing factor of 90 to one. As for pneumonia, cancer, dysentery or diabetes, let them take aspirin, or grub in the bush for medicinal herbs.

I think it is time to start questioning some of the claims made by the Aids lobby. Their certainties are so fanatical, the powers they claim so far-reaching. Their authority is ultimately derived from computer-generated estimates, which they wield like weapons, overwhelming any resistance with dumbfounding atom bombs of hypothetical human misery. Give them their head, and they will commandeer all resources to fight just one disease. Who knows, they may defeat Aids, but what if we wake up five years hence to discover that the problem has been blown up out of all proportion by unsound estimates, causing upwards of $20 billion to be wasted?
Send comment on this article to the editor of the Spectator.co.uk
A note on style

Sound sensible? Well, now it is proving out, with today’s news.

The bottom line for new readers of this vexed, super-politicized paradigm dispute, awash with billions of dollars and infested by an army of professionals living off the proceeds, is this: do you not think that Malan sounds a lot more reliable in approach, style and tone than the paradigm enthusiasts among the scientists who live off the current paradigm, such as the loud and insulting John P. Moore and his confreres?

Those who think so can be assured that today and tomorrow’s headlines will continue to prove them right, since the scientific literature of the field now continually backs the skeptics with an endless series of papers proving them right, after all, to doubt the science of John Moore (who writes many of the papers proving the doubts of the very “denialists” he attacks so unpleasantly, as we will show in our next post), Anthony Fauci, Robert Gallo, Mark Wainberg, and Jean Bergman, a development which was always heralded by their rather appalling style, with its very telling lack of respect for scientific debate and the questioning which lies at the foundation of scientific progress.

The other shoe they fear will drop, but when, only destiny knows. The $20 billion or more a year involved in HIV=AIDS is one of the greatest tests of truth that has ever been visited upon the frail shoulders of homo scientificus, if you’ll excuse our pig Latin. Only one man at the top of the field has so far shown himself beyond its influence.

One Response to “African AIDS badly overblown, UN confesses”

  1. MartinDKessler Says:

    Well, I guess the mendacity squad of the AIDS Establishment will have to come up with another way to make these poor people sick. Their spin-meisters must be working double duty to come up with an explanation to keep those dollars and Euros flowing.

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