African AIDS Cases Overstated?

Great Debates
1

I came across an intriguing article* the other day. The basic thesis is that many of the African AIDS cases are actually traditional diseases not related to HIV at all.

The way the medical community traditionally defines AIDS is by correlating some 30-odd diseases found in conjunction with HIV. However, to diagnose AIDS in Africa, no HIV test is needed. It is the presence of the symptoms only that determines whether AIDS is the diagnosis.

The author contends that the CDC wanted to esablish a diagnostic definition of AIDS to be used in poor countries that lacked the equipment, funding, and field personnel to do blood tests.

Makes sense, I guess. But does that not just create a jumbled mess where the numbers are so suspect as to be invalid?

The diagnosis for AIDS (with no HIV test) then rests upon such symptoms as prolonged fevers, significant weight loss, and prolonged diarrhea. Well, a lot of things in Africa (parasites, TB, malaria, bacterial and other infections, dysentery, etc…) can cause all that with nary an HIV case to be found.

Another point the author makes is that even when an AIDS test is used (mostly in South Africa), false positives are common with conditions not related to HIV (it seems that the particular test is not all that reliable, and follow-up confirmation tests are all but non-existent). But the results are extrapolated across the continent.

This, in adittion to all the cases being tallied as described above, leave us pretty much in the dark when it comes to the actual spread of AIDS across Africa, unless “Gee, it seems like a lot” is a valid census procedure.

So, for the purposes of a debate…is there something to this? What are the implications, either medical or political?

  • The article was by Tom Bethell in The American Spectator, which is politically aligned with the Right. However, I do not believe that changes the facts of AIDS enumeration (of course, if you disagree, that just means a better debate!), only the interpretation of the implications of the policy.
2

I’d think that if a patient merited those symptoms, even if they don’t do an HIV test, they probably have do do other tests to see if it’s another disease (TB, etc.) as they are just as dangerous as AIDS.

But then, I’m no medical professional, and certainly not acquainted with practices in Africa. I’ll ask Dr. Boyfriend, as he got his masters in epidemiology.

Esprix

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3

Of some interest to note, all/most of those African AIDS cases are counted as "hetero- sexual contact cases. There seems to be good info that many are spread thru needles and homosexual conduct (“not that there’s anything wrong with THAT”).

4

Daniel said:

Care to provide that “good info”?

5

There are many documented cases of health worker reusing needles for inoculations. One of the site managers was quoted “if we have to make a choice between a near 50% mortality rate on some of these plaques, compared to a 1 in 10000 chance of a patient contracting aids, we’ll have to make that choice, hard as it is. We simply do not have the funding to provide new needles for every patient” This was rather a big scandal as the WHO was involved. I can see his point, tho. Drug use in the cities is just as bad as it is here, drugs are a refuge for poor people anywhere. It is just that some 3rd world nations lie about it, and many other statisics. In some tribes the men have secret sexual parties, with each other, as part of a “ritual”- as these men do NOT consider themselves “homosexual” (and there is much less tolerance for Gays in 3rd world nations, anyway), they say “NO” to any questions about homosexual encounters. The health workers are more concerned with treatment, than getting good stats, and you can hardly attack them for that.

I will try to dig up the articles I read these in, I might be able to find these on the web.

6

Those are very interesting facts that Danielinthewolvesden posted. I was not aware of that particular aspect of African AIDS. Like DavidB, I do hope you can post some cites.

Yet another problem, at least in South Africa, is the reluctance, if downright refusal, for the S.A. president to accept conventional Western measures for the detection and treatment of AIDS.

According to recent newspaper articles, he is leaning toward the Duesburg hypothesis (HIV not a causitive agent for AIDS). He appears to be very suspicious of outsiders and their efforts to help with S.A. policy.

So what do we do about AIDS in Africa? It seems to me that this thread has addressed at least three fundamental problems: Leaders following generally discredited theories; a misrepresentation of causes; and a misrepresentation of the overall numbers.

If a certain percentage of Afican “AIDS” cases are actually traditional diseases/problems stemming from abject poverty, unsanitary conditions, and little to no real medical testing or coherent policy, then how can anyone get a handle on what to do about the problem?

Is it the duty of outsiders to dictate African AIDS policy? What if certain African countries don’t want outside help, and actually resent it?

Even if the U.S. wants to help (and I think we should), how do we go about making sound medical and policy decisions if we can’t even get accurate information on something as basic as the number of AIDS cases, and how the numbers break down as far as transmittal agents go?

7

I believe that the US does not really want the facts known. They hope that the #s coming out of Africa, esp as re heterosexual sex, will scare people away from having sex.
Now, I am not so much a conspiacy nut to believe the US would deliberately LIE, but spread #s with a shakey basis as propaganda, yes.

8

From Danielinthewolvesden:

I disagree with the motive you would assign to the US for encouraging misrepresentation on the number of AIDS cases or transmission vectors. You suggest that it is an attempt to control sexual behavior.

I certainly don’t put it past the US (especially the current administration) to fudge AIDS numbers, or accept fudged numbers from Africa. However, I see it as a funding issue. More cases = more money.

What does any group do when they want money? Report “crisis” numbers. Remember the 3 million homeless fiasco? The Super Bowl wife-beating connection? If the CDC defines African AIDS in such a way as to exaggerate the number of cases (the premise of the OP) or mis-states transmission vectors (your contention), then other nations will pay more attention and send more money/personnel. That’s the theory, anyway.

Some may say “Well, so what. As long as the situation is forefront and help is being sent, what difference does it really make as to specifics?” To some extent this is true. Help is help and more is certainly better than less.

But name me anyone in the field of science or medicine who wouldn’t rather work from a basis of accurate information (politicians are a different matter altogether). It is important to know if a certain African country has 3 million AIDS cases, or 1.5 million AIDS cases and 1.5 million other diseases that could be addressed more efficiently if we didn’t just lump them all together and call them “AIDS.”

9

DIVE: I will certainly accept funding as at least as good of a motive as trying to stop sex. Thanks.

10

So they just use dirty needles? Certainly they could sterilize the needles with bleach or something, right?

Oh, and here is a link to a CNN story about South African President Thabo Mbeki’s rather whacked-out belief that HIV doesn’t cause AIDS.

11

STAR: they do attempt to sterilize the needles, but that is not 100% effective, nor is it always available. That’s why they figure the danger is low. I’m not saying they are wrong given the circumstances & alternatives, but…

12

And here is a link to excerpts from the story on African AIDS in this month’s Scientific American:

[uri] http://www.sciam.com/2000/0500issue/0500ezzel.html
[/uri]

Kimstu