HEALTH: by Professor Charles GeshekterNews Weekly
Treatable diseases rampant through Africa
, February 26, 2000
Rates of death and disease show how desperate is Africa's need for medical and infrastructure assistance.
Professor Charles Geshekter, Professor of African History at California State University, Chico, California, argues that because AIDS has such a high priority on medical resources, more common, treatable (yet often more deadly) diseases continue to cut a wide swath through the continent.
USA Today warns about 'a time bomb ticking south of the Sahara'. A UN press release calls it the 'worst infectious disease catastrophe since bubonic plague.' UNICEF says it's 'the modern incarnation of Dante's Inferno.' Newsweek claims that 'Africa is in a medieval death grip.'
This is how the media routinely describes AIDS in Africa. As an historian of Africa, I'm appalled by their groundless metaphors and contrived numbers.
A dispassionate review of the scientific data about AIDS and HIV in Africa provides abundant evidence to rebut the lurid, tabloid-style claims. I recently made my 15th trip to the continent to find out more.
The World Health Organisation officially defines an AIDS case in Africa as a combination of fever, persistent cough, diarrhea and a 10% loss of body weight in two months. It is nearly impossible to distinguish these common symptoms - which I've had while in Somalia - from those of malaria, tuberculosis or malnutrition.
And since 1994, even tuberculosis itself has been considered an AIDS-indicator disease in Africa. When collapsed into acronyms like HIV/AIDS, HIV/TB, or HIV/STD/AIDS, a variety of old sicknesses have been reconfigured to form a newly-defined 'emerging disease'.
Post-mortems or autopsies are seldom performed to determine the actual cause of deaths in Africa. According to the Global Burden of Disease Study at Harvard, Africa maintains the lowest levels of reliable vital statistics for any continent - a microscopic 1.1%.
Thus, 'verbal autopsies' are widely used in Africa since death certificates are rarely issued.
To watch terrifyingly large 'numbers' dissolve into vague 'estimates', ask an AIDS expert to distingiush the sweeping projections of the incidence of HIV from actual confirmed AIDS cases.1
The most reliable statistics on AIDS cases in Africa are contained in the World Health Organisation's 'Weekly Epidemiological Record'. Its latest figures, published in November 1999, indicate the total cumulative numbers of AIDS cases reported throughout Africa since 1982 is 794,444.
On a continent of 650 million people, that amounts to approximately 0.2 per cent, over a 17 year period. If anyone wants to disprove those numbers, he should provide better, more reliable, locally-based figures. This far, no one has.
Moreover, statistics on HIV prevalence in South Africa are based on annual surveys at select pre-natal clinics. In a country of 42 million, about 18,000 pregnant Africans may take a single HIV test. The percentage that registers antibodies to HIV is then simply extrapolated and projected onto the entire population.
But the blood test used - known as ELISA - is notoriously unreliable in these circumstances, since pregnancy is one of 70 conditions known to trigger a 'false positive' result. Even the packet insert in the ELISA test kit from Abbott Labs contains this disclaimer: 'There is no recognised standard for establishing the presence or absence of HIV-1 antibody in human blood.'
A systematic survey from central Africa confirmed that endemic infections among impoverished populations resulted in so much cross-contamination that the non-standardised ELISA technique was rendered useless.
Nevertheless, with missionary-like zeal, condom manufacturers and AIDS fund-raisers make unsubstantiated claims, attributing these widespread clinical symptoms to a so-called 'African sex culture'. Reverend Eugene Rivers of Boston has launched a crusade to change African sexual practices. His insinuations are eerily reminiscent of Victorian voyeurs whose racist constructs equated black people with sexual promiscuity. Then, as now, its purpose was to justify Western intervention in order to 'save Africans'.
In South Africa, site of the next International AIDS Conference in July 2000, criticism of the HIV/AIDS orthodoxy is on the increase as many Africans have condemned the deceptive marketing of anxieties.
South African President Thabo Mbeki launched an investigation into the safety and health benefits of AZT, a toxic and expensive drug that produces metabolic abnormalities in laboratory animals, and whose life-extending benefits remain unproven.
For those reasons, the Minister of Health, Manto Tschabalala-Msimang (a physician herself), told South African television audiences in December that she would never recommend AZT, advice echoed on the same program by Dr Sam Mhlongo of the National Medical University in Pretoria.
During my recent visit, I had a conversation with Ms Thuli Nxege, a 28-year-old domestic worker from a rural Zulu township outside Pietermaritzburg. I asked what made her neighbours sick. She cited tuberculosis, then added that the lack of sanitary facilities and having open latrine pits adjacent to village homes impeded people's ability to properly prepare clean food. 'The flies, not sex, cause 'running tummy' [diarrhea],' Thuli told me.
Mrs Beauty Nongila, principal of a rural school in north Zululand, insisted that 'more toilets' would improve the health of her students. Her sparcely-equipped Thukela elementary School has four toilets for its 408 students. She struggled to provide her underfed kids with a spartan lunch on an allowance of 8 cents a day. When I inquired about the AIDS crisis, Beauty laughed and cited dental problems, respiratory illnesses and chronic hunger as far more vexing.
There are no empirical studies to confirm the sensationalist claims of exploding numbers of African orphans. Amidst the rampant alarmism and statistical discrepancies, is every barefoot African child with a running nose who isn't accompanied by an adult now considered an AIDS orphan?
Wearing red ribbons or issuing evangelical calls to condomise the continent will do nothing for the health of Africans.
Rather than add an extra $150-200 million in the US budget for behaviour modification schemes or to pursue an illusory AIDS vaccine, as US Vice-President Al Gore has proposed, American tax dollars could subsidise inexpensive but effective medicines to treat the common illnesses which are the product of impoverished living conditions.
The money can purchase antibiotics to treat syphilis and gonorrhea, rehydration tablets for diarrhea, directly observed therapy with anti-microbial medicine for tuberculosis sufferers, and micronutrients and vitamin supplements for pregnant women and breastfeeding mothers, regardless of their alleged HIV status.
These strategies are not sexy, but they will improve people's health. What are we waiting for?
1 p.401 (http://www.who.int/wer). In other words, one must be able to 'put his statistics on the table', as University of Chicago statistician, Stephen Stigler, puts it. (Stephen Stigler, Statistics on the Table: The history of Statistical Concepts and Methods, Harvard University Press, 1999)