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| AIDS in Africa: What's Really Going On? |
AIDS in Africa: What's Really Going On?
We've all heard the numbers: 40 million dead. 200 million plus infected with HIV. Tens of millions of children without their mothers and fathers, roaming the streets and dying or growing up feral, creating a generation without an anchor, a generation of chaos.
The answer, we are told, is to continue pouring money into AIDS research. If it weren't for the greedy pharmaceutical companies, these dying mothers and children could get the medications they need.
As always, we Westerners are shortsighted where Africa is concerned. There is undeniably a terrible AIDS problem. And I'll grant that pharmaceutical companies are greedy, and having worked in one I can also say they are wasteful. But Africa's problems extend further than this, and we are not being told the truth.
AIDS Testing In Africa
We're being told that the AIDS epidemic is horrendous in Africa . Millions are dying, millions more infected. There are tragic pictures of crying children, anorexic women receiving minimal medical care in canvas-roofed huts. And being who and what we are, we give and give and contribute more.
But over the first nineteen years of AIDS records being maintained, the World Health Organization counted only 876,009 cases – much less than even a single million. And only in 1997 did the cumulative number of AIDS cases in Africa – a very large continent, though it looks small on our maps – surpass the cumulative number in only the United States. More people die in a single year of heart disease in the United States than die of AIDS in Africa. Yet the WHO estimates there are over 25 million in subSaharan Africa with HIV. And many nonprofit organizations say that the numbers are growing.
So why is there such a disparity in the numbers with HIV and the numbers with AIDS?
One reason is that a large proportion of Africans test positive on HIV antibody tests, while few Americans do, yet few HIV-positive people actually go on to develop AIDs. Another is that our AIDS tests in Africa seem to be picking up other diseases too: HTLV-1, for instance, a related and endemic disease in Africa. There is evidence for other related diseases in Africa as well: Kaposi's sarcoma is fairly common in Africa and has existed there since ancient times, though in the West it's associated strictly with AIDS. Both Western and African AIDS scientists have concluded that ELISA and Western Blot testing, the most common, reliable, and inexpensive AIDS tests in the West, are not reliable for AIDS testing in Africa. By one scientist's count, about 70 diseases and conditions can cause false-positive test results on one or the other AIDS test – and few patients are tested more than once.
Here's the solid truth: because of this fact, and because of the expense involved in any AIDS test, most Africans aren't tested. Instead of using tests, Africans are diagnosed clinically, with a methodology developed by WHO in 1985. This methodology defines AIDS as marked primarily by persistent fever, diarrhea, and weight loss – symptoms identical to a dozen common African ailments that are not AIDS, including malaria.
Only in Africa because of their special issues can AIDS be diagnosed by symptoms alone.
Individual African countries, in addition, have developed their own clinical case definitions, sometimes with more accuracy, and sometimes with more relaxed criteria, perhaps because by relaxing the criteria, they get a higher AIDS count and thus more money from WHO and the rest of the world to treat AIDS. In some countries, almost anything can be classified as AIDS, and in some cases even these very lax criteria are not adhered to.
To make things worse, manufacturers of AIDS tests routinely exclude non-Western populations when they determine the efficacy of their tests. The result: there is no way to tell whether a given test will work on Africans at all.
Yet the media persists in misinformation. Newsweek reported there were AIDS deaths numbering "2.2 million in 1998 alone." Pretty remarkable since the WHO only had about 800,000 reported cases at that point.
One disease commonly misdiagnosed in Africa as AIDS is malaria.
The Malaria Controversy
Malaria is a disease we can say with some certainty kills millions – about one million each year, 90% in young African children. Even in those who do not die of it, malaria becomes a systemic and pervasive problem, sickening them and making them more susceptible to other deadly diseases.
And malaria used to be a worldwide disease, affecting the United States and Europe as badly as other regions of the world more closely associated with it today. For years in the first part of the 20th century, mosquito spraying was a regular occurrence in the West to combat malaria. Large cities like New Orleans were heavily afflicted, to their detriment. And then a chemical was invented that eradicated the problem completely in the West: DDT.
DDT was remarkable when it was used in the 1950s. Within only a few years, it eradicated enough of the mosquito population that malaria was rendered extinct in the areas where it was used. But in the late 1960s and early 70s, some researchers started publishing disturbing data on DDT.
First, it appeared that DDT cas a carcinogen in humans, and that we acquire it in the food chain when widepread spraying is engaged in. Second, evidence that DDT was harming endangered raptors came to light in a famous study, accompanied by photos of damaged egg shells, in the 1970s. The United States adopted widespread restrictions on DDT use in the early 1970s that effectively eliminated its use as a malaria-fighting agent.
This no longer mattered to the U.S. and Europe ; malaria had been eradicated. But because of poorly-organized delivery infrastructures, inability to reach key areas, and some local resistance, the DDT treatments had not reached all of Africa .
The result? Today's Africa is as susceptible to malaria as ever. Worse, there are populations of mosquito that have developed a resistance to DDT, and
DDT is frequently not used in Africa for several reasons. First, USAID favors alternatives to DDT because of fears of DDT's dangers. Second, many European countries refuse to purchase produce and other foodstuffs from African countries which use DDT, even though it has been shown that plants and herbivores pick up only trace amounts of DDT from their environments even where spraying is heavy.
This is not to say that DDT is the answer. In some countries, DDT was overused, or misused in ways that led to the rise of DDT-resistant mosquitoes. But if DDT were once again used in controlled mass-sprayings instead of limited to inside households, it is possible that in some parts at least of Africa, malaria and other insect-borne diseases would decrease. This may be particularly true in areas where people live in refugee camps, where it is nearly impossible to use indoor spraying of DDT and mosquito nets for everyone in the way they are intended, and where disease is rampant.
Conclusion
Is DDT the answer to Africa 's AIDS problem? No. It may be a beginning, in some regions, to resolving misdiagnosed malaria, which is a huge proportion of supposed AIDS cases. But Africa's problems go much deeper than nature. Warlords and pirates both take a toll on the free movement of trade, and the medical infrastructure throughout the continent is so scant as to often be nonexistent.
Throwing money at AIDS will not fix these problems. UN peacekeepers will not fix these problems. Only patience, the support of the rest of the world, and the intelligent application of science in ways that best use the vast resources well-meaning people want to send to Africa will make any headway. The question is whether the world possesses that patience, with its fickle channel-flicking habits and the huge distraction of the crises in the Middle East. |
| Average rating: 4 | Add 24 Feb 06 Dr Botkin |
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| Comments |
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| Araali michael |
its really high time the world raised arms and combert mostly the disease, like malaria in Afrca, because its more deadly than H.I.V.
2. Find ways of taming mycobacterium which causes PTB,
3.Sending funds Africa to fight the deadly diseases my not be the ultimate solution but coming the ground and find out the real route cause. |
| Araali michael. |
whe you read the report from the developed countries concernig Africa(H.I.V/A.I.D.S)
I mean the situation is over exergerated and you may think in African there`s no health person.
eg how can you sample Uganda and Ivorycoast about H.I.V.and you generalise the continent.
personally would be grateful if the image of Africa is not damaged by the developed world.
Greetings from Uganda-Jinja Regional Referral Hospital. |
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