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I have never made but one prayer to God, a very short one: “O Lord make my enemies ridiculous.” And God granted it. – VoltaireDavid Brooks’ fantastical view of Africa
The newest addition to the Times Op Ed lineup has been mightily impressed by his tour of southern Africa last week, courtesy of the AIDS priests in that resource-challenged part of the world.
Today (Sun Jun 12) we are treated to a column from Mozambique, which paints the African health picture in lurid terms as a conundrum of moral, sociological, psychological and cultural issues, which the mighty technical prowess of modern science is powerless to solve.
“In the week I have spent traveling around southern Africa,” says Brooks, “I have been struck by how much technical knowledge we have brought to bear combating AIDS. You give us a problem that can be solved technically—like creating the medicines to treat the disease—and we can perform mighty feats.”
He is also aware of of the importance of condoms to prevent the spread of AIDS, it seems, and is very happy to visit a church made of stocks, ten yards long and with a tin roof, where he finds women and their pastor fully apprised of this important tenet of his and their faith.
But then he details the cultural-moral-political-psychological factors which confound this simple palliative. Apparently in Africa men are often polygamous, beat their HIV positive wives, won’t accept “no” for an answer, get drunk and/or in the “throes of passion” and force themselves on their women. Miners have sex with prostitutes and then their wives. Teachers trade grades for sex, “sugar daddies have sex with 14 year old girls in exchange for cell phone time…. Small gangs of predatory men knowingly infect women by the score without a second thought in the world.”
As an example of the thoughtless fantasy which streams from the pens of moral-cultural-psychological-political commmentators who are let out of their East Coast zoo to roam the unfamiliar moral-cultural-psychological-political landscapes of Southern Africa it is a prize specimen.
Brooks, not unlike some greenhorn provincial touring the Soviet Union in the charge of one of Stalin’s guides, seems to have swallowed everything he is told in one gulp without tasting any of it, and then spat it out as a monster grown tenfold, like some inflated bottomfeeder.
But on top of that, it seems that offered a rare chance to moralize on the incontrovertible basis of deadly threat of disease, he is not going to miss the opportunity.
“This is an AIDS crisis about evil,” he cries, launching further fire and brimstone about a southern Africa that bhas “ten Jobs per acre” and in desperate need of a “language that governments and N.G.O’s rarely speak” which connects words like “faithful” with “abstinent”, sewn together in the fabric of “some larger creed”.
All of this oratory from the pulpit is based on one premise which Brooks apparently never thought to question, despite the experience over two decades of AIDS in his home nation, which has seen absolutely no visible spread to heterosexuals of this supposedly same disease agent rampant in southern Africa. For heterosexuals, HIV is a swiftly catching microbe on the continent he is visiting, whereas it bats close to zero in the US in the same game.
Here is another column Brooks write earlier in the week. In Namibia and elsewhere, Brooks detects a Silicon Valley-type boom in small clinics springing up everywhere as drugs become increasingly availanle and work their wonders.
Once again, scientific critics of the paradigm in AIDS are faced with anecdotes of delighted patients who feel much better after they take their doses. How could all this be wrong?
That is a hard question best dealt with in a separate post. But for now, it seems that skeptics would have to redouble their emphasis on the psychology of HIV positivity, where the assurance of death has powerful debilitating effects and when it is replaced by the assurance of salvatio, patients are equally powerfully boosted—especially when what they are worrying about does not in fact exist, as such, and they may not be suffering from anything else:
The New York Times
June 9, 2005
In Africa, Life After AIDS
By DAVID BROOKS
Windhoek, Namibia
Bobwalla is a black woman born in Cape Town and raised under apartheid. She lived in a shack with her husband, who drank and beat her for the first nine years of their marriage. Then she tested positive for H.I.V., and cried for days. It was a death sentence.
But she was lucky enough to find a clinic that could give her antiretroviral drugs. She persuaded her husband, who is also H.I.V.-positive, to get treatment. He stopped drinking as part of the treatment, and has stopped abusing her and sleeping around. Now she counsels pregnant women on how not to pass H.I.V. on to their babies.
“For some, H.I.V. brings death,” she says. “For me, H.I.V. brought life into my home.”
You come to Southern Africa to visit AIDS hospitals, and you expect, or at least I expected, to find unrelieved sadness. But something positive has happened recently because of the confluence of three factors. The first is the spread of antiretroviral treatment programs. Second, some African governments have gone on the offensive against the disease. And third, the U.S. and other countries are pouring in money to pay for treatments.
So now you run across health workers who have been laboring for years and watching people die, but who suddenly have the means to offer life. You have, amid the ocean of despair, this archipelago of hope, hospitals that are ramping up treatment programs as fast as they can, even while bursting out of their walls. In Namibia, for example, only 500 people were receiving treatment in January 2004. Now over 9,000 people are, and the number is rising rapidly.
Here in Windhoek, Namibia’s capital, you run into people like a 6-year-old who was born to parents who were both H.I.V.-positive. They gave her the name Haunapawa, which reflected their mood at the time. It means, “There is no good in the world.” But the parents are both still alive, and the girl, once racked by pneumonia, is thriving on the medicine.
You run into scenes like the one I saw at Oshakati Hospital in northern Namibia, by the Angolan border, where a young Zimbabwean doctor, Gram Mutandi, works at his clinic. Patients can wait for eight hours to receive treatment and counseling.
One woman, Josephina, had been dying of AIDS. Her mother had already died. So had her sister and brother-in-law, and she was looking after their children. Then she got on the treatment program, and now she has the irrepressible joy of someone who has come back from death.
Next to her was a woman who showed a photograph of herself at the depths of her disease, frail and emaciated. With treatment, she’s robust now. “I want to thank Dr. Mutandi,” she said. “You saved my life.”
You can imagine what this has done for the morale of the health workers. You can imagine how it has helped them in their efforts to get more people tested for H.I.V. Now a positive test is not a death sentence. Something can be done.
Obviously there’s a long way to go. You can still go out and visit children in mud huts who are raising themselves because their parents, aunts and uncles are all dead. Only a small fraction of those who need treatment are getting it. At the Lutheran Hospital in Onandjokwe, Namibia, the staff tested 858 women in the first quarter of this year, but could get only five of their male partners to even come in for testing.
But there’s something perversely akin here to Silicon Valley in the early 1990’s. All these little treatment facilities are trying to get really big really fast. Thanks in part to American money, they’re building new wings and desperately scrounging for qualified staff.
They’re facing the problems start-ups face: how to offer treatment to hundreds when you have only one sink and one phone, how to use the survivors who suddenly have the rest of their lives to lead.
I came here expecting despair, but now realize that we should be redoubling our efforts out of a sense of opportunity. I came here aware of controversies about abstinence versus condoms in AIDS prevention programs, about U.S. aid versus multilateral aid, and now realize that all that nonsense is irrelevant on the ground.
This is a world of people trying everything, of doctors from Russia, Egypt, Cuba, Germany and Zimbabwe. Many are backed by money from the President’s Emergency Plan for AIDS Relief, finally doing the work they’ve always dreamed of doing.
We could be on the verge of a recovery boom.
Of course, Brooks is as underresearched and underinformed as any other full time talking head in the US media on any topic he addresses, especially on a whirlwind tour of Africa, and it is unlikely that he would ever set his research assistants to work to nail down the inconsistencies in AIDS. But his inability to catch the simplest fundamental anomaly is striking, even with jet lag.
But then again, the mind works much harder to force inconsistencies to conform to the mental framework in place, than it does to change the framework to encompass a larger truth. Our pontificator Imagining that there might be something simply wrong about the mental projections of his guides and their medical masterminds is evidently too much to ask, for whatever reason.
What would be ideal, if unimaginable, would be for all columnists visiting southern Africa these days to be given a copy of David Rasnick’s “But What About Africa?” to read on the plane, without any access to alternative reading material.
First published as a paper presented to the Second Conference on Science and Democracy at the the Institute of Philosophical Studies, in the Palace of Serra di Cassano in Naples in 2003, Rasnick’s run down on the blatant impossibility of African AIDS as normally understood seems as persuasive as when it was delivered two years ago.
Anyone who credits the many points Rasnick makes can be relieved of the obligation to follow David Brooks, Brad Pitt, Diane Sawyer and other media stars into a fantasy of Africa as being inhabited by a race from another planet, whose magical ability to transfer HIV through heterosexual conjugation is matched only by their evilly corrupted social attitudes, recalling the darkest imaginings of the white European explorers and hunters when they first fearfully returned to the Dark Continent that spawned them eons before.
The url is at the Science and Democracy Conference Website and unfortunately nested inside frames. This makes it hard for google to find, unfortunately (someone should tell Web designers that if they want something to be seen by search engines, Don’t Use Frames).
The first page to go to to choose the language is Science and Democracy Conference: Choose Italian or English. Once clicked this leads to the full information page, where you should choose the papers from teh Second Conference, Contributions to SD2, one of which is David Rasnick’s “But What About Africa?” in both HTML and PDF.
Interestingly it also deals with the basic contentions of the Durban Declaration, which it refutes point by point, and with the widespread notion that antiretrovirals enable ailing AIDS patients to leap out of bed and climb mountains, or at the least go back to work from their sickbed.
The story is, sadly, otherwise, according to Rasnick. Click (more) for his refutation:
II. But, arenÂ’t people living longer because of the drugs?
Martin Delaney of Project Inform says that, “the multi-drug combinations have dramatically reduced death rates and greatly extended the lives of those [HIV-positive people] using such therapies” . This is a very common assertion made these days about the wonderful life-saving benefits of the admittedly highly toxic anti-HIV drugs. Let’s take a look at the evidence and see if Delaney’s unrestrained enthusiasm for the antiretrovirals is justified.
First, we must look at the CDC’s HIV/AIDS Surveillance Reports to see how AIDS has changed in the USA over the past two decades. The CDC data show that AIDS peaked in 1992 and has been going down steadily ever since (Fig. 7). The mortality rate from AIDS is dropping because AIDS has been declining in the USA since 1992, years before the introduction in 1996 of Highly Active AntiRetroviral multi-drug combinations (HAART) that Delaney touts. The apparent life-saving benefits of the HIV-protease inhibitor-containing cocktails is a consequence of the simple fact that these drugs have appeared on the scene long after AIDS peaked in the USA, during a period when the mortality due to AIDS was naturally in decline .
Another reason for the decline in AIDS deaths is the CDC’s re-definition of what constitutes AIDS in the USA. As of 1993, all you needed to qualify as an AIDS case were results from two lab tests: be immune to HIV, that is have antibodies to the virus, and have fewer than 200 CD4 cells per microliter of blood or a CD4 percentage less than 14 . The CDC has a rule that an AIDS case is classified according to the earliest definition that applies. Consequently, in 1997, 36,634 people (61% of all new AIDS cases) were classified under this non-disease category. Because the majority of new AIDS cases in the USA are classified according to the non-disease criteria of the CDC’s 1993 definition change, they do not have any of the colossal list of AIDS diseases—from diarrhea to dementia, pneumonia to cervical cancer—required by earlier definitions. Thus, the majority of new AIDS cases since the mid 1990s are disease-free (healthy) people. However, we can no longer follow the nationwide trend of including healthy people as AIDS cases after 1997 because the CDC stopped listing the AIDS-indicator diseases and conditions (formerly Table 12 ) in its HIV/AIDS Surveillance Reports.
Nevertheless, San Francisco continues to report AIDS cases according to specific AIDS-defining diseases. The San Francisco Quarterly AIDS Surveillance Report for 2000 shows in Table 10 on page 8 that 47.7 percent of all AIDS cases from 1980 through 2000 were diagnosed with AIDS according to the two lab tests of the 1993 definition change . Since this is a cumulative number, which combines all AIDS cases under four different definitions of AIDS, well over half of all people (mostly gay men) in San Francisco that are currently being labeled as AIDS cases have no AIDS-defining disease. In spite of the 1993 definition change, with its inclusion of large numbers of healthy people as AIDS cases, Fig. 8 (taken from reference ) reflects the national picture showing that the number of new AIDS cases in San Francisco has steadily declined since a peak of 760 in 1992 to below 50 in 2000, the same low level as in 1982. The number of new AIDS cases in San Francisco are now so few you could know them all by name.
As a consequence of the CDC’s 1993 definition of AIDS, over half of the people now being treated with the anti-HIV drug cocktails since 1996 (the year the HIV protease inhibitor cocktails became available) were healthy when they started taking the drugs. Delaney, mainstream AIDS researchers and the AIDS press are crediting HAART with prolonging the lives of these healthy people. Sadly, these healthy people taking HAART don’t stay healthy long. They eventually get sick from the drugs and die if they stay on them long enough .
On Africa, Rasnick concludes quite simply that
Thus, there is no evidence that HIV is spreading through sexual intercourse (or any other way) in Africa or anywhere else. Combined with the evidence that Africa is not currently being devastated and depopulated by an AIDS epidemic, the inability to document a sexually transmitted epidemic of HIV shows that a future HIV-caused AIDS apocalypse in Africa is unlikely.