|
Reprinted from The Business (UK), October 20,
2003
AIDS Sunset Gives Way to New Dawn in Uganda
By Neville Hodgkinson
“AIDS was supposed to destroy Uganda. So why is it
flourishing again? Billions will be spent on powerful anti-AIDS
drugs for the third world, but Uganda reversed its epidemic without
them…”
===
'Can Africa be saved from Aids?' asked Newsweek magazine in two
reports in 1984 and 1986, reporting that 'nowhere is the disease
more rampant than in the Rakai region of south-west Uganda, where
30% of the people are estimated to be seropositive [HIV positive].'
Newsweek was not alone. Over the next 15 years, prestigious newspapers
and magazines across the globe repeatedly published similar reports;
the consensus was that a devastating proportion of the Ugandan population
was doomed by Aids to premature death, with all the consequences
on families and the society as a whole. Their predictions announced
the practically inevitable collapse of the country in which the
worldwide epidemic supposedly originated.
The data seemed authoritative. By mid-1991, the World Health Organisation
(WHO) was estimating that 1.5m Ugandans, nearly a tenth of the general
population and a fifth of those sexually active, had the HIV infection.
WHO predicted that in sub-Saharan Africa as a whole, child deaths
in the 1990s could increase by as much as 30% because of Aids. In
November 1996, the agency reported that more than three million
children were already feeling the direct impact of Aids in Uganda
alone.
Today the public prints and airwaves are still full about the African
'Aids crisis'. But you will read little about Aids in Uganda. The
reason: all prophecies have proved false, as the results of a 10-year
census published last year has shown. Uganda's population grew at
an average annual rate of 3.4% between 1991 and 2002, one of the
highest growth rates in the world, due to persistently high fertility
levels (about seven children per woman) and a decline in infant
and childhood mortality rates. Economic development has also shown
constant growth over the same period reflecting the energy and determination
of Ugandans to improve their living conditions. Fewer people are
testing HIV-positive and nationally, the figure is now put at around
5%.
The good news from Africa comes at a time when WHO is spearheading
a massive campaign to combat Aids by raising funds to buy anti-HIV
drugs for poor people in developing countries. It says 99% of HIV-positive
people in sub-Saharan Africa who need treatment today because their
illness has advanced to Aids do not have access to the drugs. Within
two years, WHO wants the medicines to be reaching half an estimated
6m people worldwide whom it believes to be in urgent need. The cost,
along with prevention and other activities, is estimated at $10.5
billion in 2005, rising to $15 billion a year by 2007.
Pledges from the United States, European Commission and European
national governments, if fulfilled, will take Aids funding for developing
countries from $4.7 billion this year to $5.9 billion by 2005. That
still leaves a gap of nearly $5 billion. According to WHO and its
partners in the Joint United Nations Programme on HIV/Aids (UNAids),
the money is needed to tackle an Aids 'catastrophe' in which 42
million people are estimated to have become infected with HIV. Africa
alone is said to have 30 million infected, threatening economic
collapse and national security in the worst-affected countries.
These enormous, grim statistics, regularly repeated, have created
a pall of uncertainty over much of sub-Saharan Africa, especially
in the eyes of many Western investors, which further blights Africa's
economic development. The encouraging news from Uganda might have
been taken to suggest that a huge increase in funds devoted to the
anti-aids drugs would be money well spent - except that Uganda has
shaken off the worst of its apparent HIV/Aids epidemic without resort
to such drugs. Moreover, there have been other developments that
cast doubt on the validity of putting pharmaceuticals centre stage
in the fight against Aids - and even call into question WHO's entire
strategy in targeting HIV as the best way to fight AIDS.
Responding to a news report in the August edition of the British
Medical Journal (BMJ) headed 'Free retroviral drugs could save up
to 1.7 million South Africans', Dr Christian Fiala, a specialist
in obstetrics and gynaecology from Austria with a degree in tropical
medicine, has urged caution before investing in such approaches.
Since the drugs are costly and potentially dangerous, it is essential
to substantiate such claims, he says in two letters published in
BMJ on-line, the journal's website.
Fiala has spent years researching data on HIV/Aids and has worked
in Africa and Thailand as well as Europe. He is the author of a
1999 book on Aids, Lieben Wir Gefahrlich? (Do We Love Dangerously?
- A Doctor in Search of the Facts on Aids). He has looked particularly
closely at Aids in Uganda, once considered the epicentre of African
Aids but now, far from being decimated, enjoying a population and
development boom that is confounding past grim predictions.
Fiala asks: 'How can this contradiction be explained: that a land
condemned to death has not only avoided the predicted catastrophe
but that population growth has even dramatically accelerated in
this period and economic development has been positive? And more
specifically: how has it been possible to reduce HIV-prevalence
without antiretroviral therapy, the so-called Aids drugs?'
The WHO, which says most HIV infection in Africa is attributable
to heterosexual intercourse, argues that the reduction must have
come about because of a change in sexual behaviour, achieved through
high-level Aids awareness campaigns in Uganda. Fiala says there
is no reliable evidence for this belief.
On the contrary, the latest household survey (2001) shows that the
following indicators of sexual behaviour have been stable, some
for 30 years: fertility (seven children per woman); average age
for women at time of first sexual intercourse (16.7 years); age
at marriage (18 years); and first childbirth (18.5 years). The only
indicator that has slightly changed is the proportion of married
women using contraception, up over the last five years from 15 to
23%. But only 2% regularly use a condom (though 35% report unmet
needs for family planning).
'The explanation is to be sought elsewhere,' Fiala says. 'The horror
scenarios were based on the large number of people testing HIV-positive
in Uganda in antenatal surveys and numerous other studies. Most
of these HIV-positives, according to the underlying assumption,
would contract Aids in eight to 10 years and consequently die relatively
fast. Surprisingly, mortality did not increase over the last decade;
obviously, therefore, this assumption has been wrong.'
The reason, he says, is the unreliability of HIV tests, as demonstrated
by many studies. Particularly in Africa, people have high levels
of antibodies in their blood triggered by infectious and parasitic
diseases; or by exposure to contaminated blood or dirty injections.
Some of these antibodies can cause false positive results with the
HIV test. People test positive but are not infected with HIV; so
they will not necessarily die after the allotted time.
Fiala demonstrates that not only are the figures on HIV infections
unreliable and misleading, so are the official Aids statistics.
Diagnosis of Aids in Africa is based on a special definition for
developing countries which WHO decided in 1985. According to this,
Aids is diagnosed on the basis of what are known as 'non-specific
clinical symptoms'. 'Even today in Uganda and other African countries,'
says Fiala, 'people with, for example, continuous diarrhoea, weight
loss and itching are declared to be suffering from Aids. Furthermore,
the typical symptoms for tuberculosis - fever, weight loss and coughing
- are also officially considered to be Aids, even without an HIV
test.'
Perhaps this helps to explain why, despite more than one million
Ugandans said to be living today with HIV/Aids out of a total population
of 23 million, the 'My Uganda' independent website comments that
'the massive sugar and textile industries of the 1960s are reviving,
along with the large tea estates long neglected…many expelled
Asians have returned to reclaim their properties and are reinvesting
in a growing economy…tourism is attracting investment and
interest…Kampala is steadily being rebuilt…the city
infrastructure has been restored and new office towers, hotels,
stadiums and shopping malls are appearing almost monthly…the
overriding impression of Uganda is of its happy people.'
In estimating total Aids cases, until recently WHO's Geneva headquarters
added the registered Aids sufferers to a high number of unreported
cases which WHO presumed to have occurred. Thus in November 1997,
WHO announced that since its previous report in July 1996, there
had been a further 4.5m Aids cases in Africa. In this period, however,
only 120,000 Aids sufferers were actually registered. 'In other
words, 97% of the supposed new Aids cases occurred only at the WHO
Headquarters in Geneva,' Fiala comments.
WHO now prepares the statistics differently but still in a way that
keeps the numbers artificially high: healthy people with a positive
HIV test are added to diagnosed Aids cases to produce the category
'people living with HIV/Aids'. Again, this procedure is highly unusual
in medicine, Fiala says. For example, nobody has suggested putting
people actually suffering from tuberculosis alongside those who
are healthy but who have antibodies to the bacteria.
In fact, in creating such a category, WHO is reflecting the predominant
scientific view that to be HIV positive inevitably means a decline
into illness and death - a view now profoundly challenged by the
Ugandan experience.
The view arose because of a close correlation between testing HIV-positive
and risk of ill-health. In reaching such a conclusion, however,
Aids experts appear to have fallen into an elementary statistical
trap: confusing correlation with causation.
Fiala and others say the real reason for the high levels of HIV-positivity
found in Uganda in the early years of Aids was that between 1966
and 1986, under successive tyrannical dictators, the country was
wrecked by economic disaster, mass executions, civil war and war
with neighbouring Tanzania. Gross malnutrition and poverty opened
the door to devastating deterioration in health and loss of life
through an upsurge in long-standing African diseases, including
TB. By the same reasoning, the decline in HIV-positivity in Uganda
is a result of the success of the current government in restoring
political and social stability and economic development.
Powerful scientific support for Fiala's view comes from researchers
in Perth, Western Australia, who have demonstrated that the proteins
claimed by HIV experts to belong to HIV, and which are used in the
HIV test, are actually cell proteins present in all of us. People
in Aids risk groups, including gay men, haemophiliacs and drug users,
are liable to have high levels of antibodies to these 'self' proteins:
that is, auto-antibodies, arising from the immune system challenges
in their lives. Malnourished people suffering from certain chronic
infections, notably tuberculosis, have also been shown to develop
high levels of antibodies that react with the proteins in the 'HIV'
test, not because of 'HIV' but because of TB. Since millions of
people in impoverished living conditions are exposed to TB, that
alone could account for much of the so-called 'HIV pandemic'.
Reports in the medical literature document around 70 different conditions
that can give false positive results in this way to an HIV test.
The list includes infection with hepatitis B virus, a common contaminant
of blood, and even pregnancy or a course of flu jabs. So, when anyone
tests positive, it does not mean they are HIV-infected. Manufacturers
of the HIV test kits admit this. For example, Abbott Laboratories,
one of the main producers, state in their packet inserts: 'At present
there is no recognised standard for establishing the presence or
absence of HIV-1 antibody in human blood.'
The Perth group, and other scientists trying to draw attention to
their findings, say much evidence now points to HIV-positivity,
and similar measures of immune system activation such as so-called
viral load, as being a consequence rather than cause of a compromised
immune system. They argue that the mistake came about because from
the start, when HIV was first postulated as the cause of Aids nearly
20 years ago, it never proved possible to find the virus in any
workable quantity in patients.
Normally, in determining whether a virus is the particular cause
of an illness, microbiologists first purify it from a patient with
the disease so that they know what it looks like under the electron
microscope and precisely what they are working with. They then grow
the purified virus in the laboratory, show it is present in all
cases of the disease, that there is a lot of it and that it is active
in the body in a way that accounts for the disease. They also try
to reproduce the original disease by introducing the virus into
a susceptible animal.
In the case of HIV none of these requirements has been met, according
to Eleni Papadopulos-Eleopulos, a medical physicist and cell biology
expert at the Royal Perth Hospital. She says the root of the problem
has been an inability to take the first step, of purifying the virus.
This requires obtaining a concentration of 'HIV' particles, separating
them from other constituents of disrupted cells, photographing them
(with an electron microscope) in that isolated state and characterising
them as a unique set of virus particles. Most claims of 'virus isolation'
in Aids literature refer to a variety of indirect signals presumed,
but never proven, to indicate HIV's presence.
Particles which HIV scientists have presumed to be the virus can
appear when immune cells are cultured in the laboratory. But for
that to happen, the cells have to be chemically stimulated, then
mixed and grown for several weeks with abnormal cells (obtained
from leukaemia patients or foetal cord tissue). With such complicated
procedures, it is not clear whether the particles really indicate
the presence of an infectious virus, or are simply natural products
of the over-stimulated cells.
None of 150 chimpanzees inoculated with 'HIV' produced in this way
developed Aids as a result. After 20 years and billions of dollars,
scientists have never been able to demonstrate how the particles
they have termed 'HIV' could cause the collapse of the immune system
seen in Aids.
In a series of extensively referenced papers, Papadopulos-Eleopulos
and her prime collaborators, a consultant physician, Val Turner,
and a pathologist, John Papadimitriou, argue that whatever the condition,
whether Aids as originally described in the first US victims or
the long-established illnesses that have come to be described as
Aids in Africa, a positive test result does not demonstrate HIV
infection but is a non-specific marker for a variety of conditions.
The belief that almost all people who test HIV-positive are infected
with a lethal virus has not been scientifically substantiated.
'Just to see particles in the tissues, and fail to look for evidence
that it is an infective virus, is wrong,' says Papadimitriou, a
professor of pathology at the University of Western Australia renowned
for his work on electron microscopy. 'Are these particles that cause
disease? The proper controls have never been done.' Of Aids in Africa,
he comments: 'Why condemn a continent to death when you have other
explanations for why people are falling sick?'
The elusive nature of 'HIV' meant that scientists were never able
to validate the 'HIV' tests by showing the presence of virus in
people who test positive, or its absence in those who test negative.
Instead, test kits were calibrated to give a positive result when
a person has high levels of the antibodies that the test detects;
and negative when the level is low. High levels can indeed be shown
to correlate with ill-health, low levels to good health. So the
test kits are useful as a broad screen of blood quality, for example,
or of the general health of a group of people. But in accepting
the test as indicating infection by HIV, WHO and related authorities
made what appears to have been a terrible scientific blunder.
HIV pioneers such as Robin Weiss, now Professor of Viral Oncology
at University College, London, who developed the UK's first HIV
test, admit the early tests gave misleading results by reacting
with infections other than HIV. They say that later versions of
the tests overcame these problems. However, they have presented
no evidence for that assertion. The Perth group say all versions
of the test are intrinsically defective because of the failure to
validate them by showing the unequivocal presence of the virus in
patients. Even repeatedly positive results are no guarantee that
a person is infected with HIV.
'When the principle of the test, the basis of it, has not been established,
it doesn't matter how many times you repeat it, you still won't
prove anything', Papadopulos-Eleopulos says.
Regulatory authorities have known for years that the test does not
diagnose or screen for risk of Aids; but hysteria was so great in
the early years that they chose to wash their hands of the problem.
As far back as 1986, an official of America's Food and Drug Administration
(FDA) told participants at a WHO meeting that the primary use of
the test was for screening blood donations and that 'it is inappropriate
to use this test as a screen for Aids or as a screen for members
of groups at increased risk for Aids in the general population'.
He added, however, that enforcing this intention 'would be analogous
to enforcing the Volstead Act, which prohibited alcoholic beverages
sales in the United States in the 1920s - simply not practical.'
Fiala points out that, however good the intentions may have been,
conducting the fight against Aids on this misleading basis has fatal
consequences. For example, in 1999 UNAids urged finance ministers
in African countries to cut their budgets for social security, education,health,
infrastructure and rural development, in favour of the fight against
Aids. As a result, non-Aids problems have suffered years of neglect
because of the panic created by WHO's distorted policies and statistics.
In Uganda, there were 4,000 aid organisations in 1994 active in
the fight against HIV/Aids; yet many people still have no access
to clean drinking water, Fiala found. 'In 1990 the figure was 56
% [with clean water]. Ten years and millions of dollars later, it
was 50%.' In Kyotera, a town in the Rakai district, a particularly
large amount of money had been spent on Aids, because it was supposed
to be the most heavily affected. 'Despite millions of aid funds,
campaigns for abstinence and the distribution of condoms, the people
of Kyotera still have to get their water during most of the year
from an unprotected water hole which they share with cattle.'
Aids experts tool around the country in four-wheel-drive, air-conditioned
vehicles, says Fiala, 'if they are not saving the world from Aids
in their comfortable offices or presenting their latest medical
experiments on Africans at an overseas conference. The [Ugandan]
government has not only bought condoms for millions of dollars on
credit, but borrows even more money from the industrialised countries
to buy imprecise HIV tests and toxic Aids medications.'
He concludes: 'The Aids hysteria of the last 20 years was indeed
politically correct, but led to a neglect of other far more important
aspects in health care.' While innumerable western companies, NGOs,
international organisations and Aids experts profited from it, it
was to the disadvantage of the people in Africa. 'Now, to err is
human,' says Fiala, 'but a policy that is obviously based on false
assumptions and has predominantly negative effects for those concerned
has to be discarded or adapted.
'Adhering to it leads to questions regarding the responsibility
of the decision-makers. The never more urgent question thus arises
of when the current policy will be rethought and adapted to the
priorities of the population. People in Africa need help and support.
But it is neither helpful nor effective if wrong data and absurd
definitions are employed to mislead and divert attention from the
real problems.'
Neville Hodgkinson
Nuneham Park, Nuneham Courtenay,
Oxford OX44 9PG, UK
neville@bkwsugrc.demon.co.uk
FAQ's
References
|
