Reprinted from Spiked-Central, August 2, 2001
AIDS in Africa: Why the West is Interested
By Dr Stuart Derbyshire
“The discussion about HIV / AIDS in Africa invites
visions of apocalypse. But how much does it tell us about the extent
of the disease?”
The most recent estimates from UNAIDS suggest that 34 million people
worldwide are either living with AIDS or infected with HIV, with
a cumulative 19 million deaths since the beginning of the pandemic.
The vast majority of these numbers derive from Sub-Saharan Africa.
But the numbers should be treated with caution. One concern is the
low number of sites collecting data in urban areas and the variability
in rural regions. Another is that there is no information as to
the quality of the data collected from any of these sites.
The international focus on HIV/AIDS seems to be less a result of
a concern about public health than it is about Western nations using
the issue as a way to justify more intervention into, and control
over, African societies.
African populations are being coerced into seeing themselves as
the victims of their own backwardness, and African leaders encouraged
to act as if they are liberals living in Southern California.
Twenty years into the AIDS pandemic, the one thing that is still
sorely missing is a detached scientific enquiry.
There are six diseases that cause 90 percent of the total infectious
disease deaths worldwide: measles, malaria, TB, diarrhoreal diseases,
acute respiratory infections, and AIDS. All but AIDS are curable,
at least to some degree.
Yet measles, malaria, TB, diarrhoreal diseases, and acute respiratory
infections have routinely killed millions of people in the developing
world without special sessions of the United Nations being called,
and without any expectation of continental collapse, talk of extinction
or international assemblies to mobilise preventative and treatment
measures. Why the level of interest in AIDS?
On 25 June 2001, the United Nations General Assembly opened its
first special session devoted to a disease. The aims of the three-day
meeting were to set health goals and HIV infection targets for countries
to meet over the next few years and to establish a global fund for
AIDS. Representatives attended the meeting from most countries,
including secretaries of state Colin Powell for the USA, and Clare
Short for the UK, and a host of African presidents and other heads
Western leaders vied with their African counterparts to present
the problem in the most frightening language possible. US ambassador
to the UN Richard Holbrooke stated that, 'of all the major problems
we face today - wars, famines, racial conflict, terrorism, nuclear
weapons - the greatest threat comes from AIDS'. With allusion to
the bubonic plague, he added: '[AIDS is] the most serious health
crisis in 700 years [and] a direct threat to social and political
and economic stability.' (1)
Dr. Peter Piot, executive director of UNAIDS, went one better and
brushed past the plague: 'We are facing the most devastating epidemic
humanity has ever known.' (2) Little wonder that Pakalitha Mosisili,
prime minister of Lesotho, said his government had declared HIV/AIDS
'a national disaster'.
Writing in the New York Times, Mozambique prime minister Pascoal
Mocumbi voiced his concerns about the consequences of losing a generation
or two of people and the possibility that over a third of 16-year-olds
would die before the reaching the age of 30 (3). Speaking at the
UN General Assembly special session on AIDS, President Olusgean
Obasanjo of Nigeria suggested that 'the prospect of extinction of
the entire continent looms larger and larger' (4).
As a call to action against AIDS, these apocalyptic visions are
certainly effective. But how much do they represent the true impact
of AIDS in Africa?
Just over five years ago I wrote a series of articles examining
the AIDS pandemic (5, 6). In some I criticised the Global Programme
for AIDS (GPA, superseded by UNAIDS in 1996) and the World Health
Organisation (WHO) for exaggerating AIDS figures in their projections
and relative to other infectious diseases (6). In the summer of
1994, WHO estimated that 16million people worldwide were infected
with HIV and that figure was expected to increase to 40 or 50million
by 1999, with 90 percent in developing countries (7).
There is no information on infections in prostitutes, injecting
drug users, blood donors or gay men
The numbers today are not as high as those predicted in the early
to mid-1990s, but they are startling nonetheless. The most recent
estimates from UNAIDS suggest that 34million people worldwide are
either living with AIDS or infected with HIV, with a cumulative
19million deaths since the beginning of the pandemic (8). The vast
majority of these numbers derive from Sub-Saharan Africa, which
is home to 24.5million of those currently living with AIDS or infected
with HIV and which has suffered some 16million of the total death
With an estimated 2.2 million deaths from AIDS in 1999, AIDS now
exceeds the annual death toll from malaria in Sub-Saharan Africa
and far outstrips those deaths from other infectious diseases such
as TB. (Although it is still some way from challenging the 3.3million
annual deaths from diarrhoea.) (9)
However, the numbers should be treated with caution, and put in
perspective. The World Health Organisation (WHO) provides figures
for African countries (10, 11) based, not on the total population
of each country, but on the population of ages 0-49 years. This
immediately makes the figures difficult to interpret and provides
a false sense of the extent of the infection.
In Mozambique, for example, the adult rate of HIV infection is reported
at 13.2 percent based on the proportion of adults aged 15-49 who
carry the infection (10). This is an important demographic, being
the most productive section of society. But it is a misrepresentation
to report that headline figure as being the rate of HIV infection
in Mozambique, which is what consistently happens. The actual rate
of HIV infection is six percent when calculated for the total population,
and the adult rate is 10.1 percent when calculated for the total
adult population (everybody over 15) (12).
The representation of the statistics is an issue, but the way these
statistics are derived is critical. A large number of surveillance
centres for AIDS have been put in place across Africa since 1995,
meaning that we can have a lot more faith in the numbers than previously.
Even so, there are substantial difficulties in collecting good disease
data in a country as impoverished and underdeveloped as Mozambique.
Despite the best efforts of an army of AIDS investigators, there
are only two surveillance centres in urban areas and six outside
major urban areas. Data at all sites is only collected from pregnant
women and suggest an adult prevalence rate of 11.2 percent in urban
centres and 17 percent in rural areas. This latter figure is at
the upper end of a wide range across the six sites, from a reported
prevalence of five percent to 18.3 percent.
One concern is the low number of sites collecting data in urban
areas and the variability in rural regions. Another is that there
is no information as to the quality of the data collected from any
of these sites. We have no information on the numbers of patients
tested or the reliability of the test used. We do not know if these
women were self-selecting based on their fear of infection, because
they were carrying a secondary sexually transmitted disease or because
of some other health problem. Any one of these factors could inflate
the estimated number of HIV infections. (On the other hand, the
complete absence of men from testing may be artificially deflating
the rate of HIV infection, because men may be more likely to become
There is also concern about what information has not been collected.
There is no information on infections in prostitutes, injecting
drug users, blood donors or gay men. How the disease is being transmitted
and where health resources should be directed, therefore, is impossible
to judge. These problems are not considered in press reports that
simply repeat the mantra that HIV in Africa is heterosexually transmitted.
To what extent this is true has never been established.
Five percent of the Nigerian adult population at risk of
death is tragic, but it is not the basis for extinction.
Reports from Nigeria suggest a much lower infection rate than Mozambique,
with an adult (15-49 years of age) rate of 5.1 percent (11). Again,
this figure inflates the total population rate, which is 2.5 percent.
The data from Nigeria is much more reliable, however, based on surveillance
data from 10 urban and 63 rural sites. The average rate of infection
reported from urban areas is 4.5 percent and from rural areas 4.9
percent. As for Mozambique, the range is greater in rural areas
(0.54 - 21 percent), implying that rural collection is less reliable.
The range in urban areas (2.7 - 8 percent) is much tighter, but
still not insignificant.
Without details of the quality and mechanisms of data collection
it is difficult to offer much further interpretation. Again, there
has been no collection of data from men or the general population
through blood donation, rendering the population extrapolations
made by UNAIDS and other groups an educated guess based on the sampling
of pregnant women.
Discounting the potential problems with the UNAIDS figures and accepting
them at face value, it remains difficult to justify the suggestions
of apocalypse now. Five percent of the Nigerian adult population
at risk of death is certainly tragic, but it is hardly the basis
for expecting extinction. Moreover, the developing world is no stranger
to disease and pestilence and continues to be ravaged by a myriad
Measles kills one million children a year but can be easily prevented
with vaccination. Rotavirus causes severe diarrhea in 125million
children a year and kills 600,000 of them, yet it can be easily
treated with oral rehydration or intravenous fluids. Hepatitis B
kills more than a million adults a year and can also be prevented
by vaccination. Worms like hookworm and schistosomiasis infect 1.3billion
people a year, mostly through working or playing in fields that
double as latrines or swimming in infected lakes and streams. Three
hundred thousand of these infections lead to death and for those
that survive repeated infection and re-infection can stunt growth
and produce years of discomfort. Each worm can be treated with one
or two pills costing $1.
So it is worth asking again, why is so much international attention
given to AIDS, and so little given to these other diseases? Beyond
the hyping of a tragedy into a catastrophe, at the United Nations
General Assembly special session on AIDS there was a more pernicious
agenda coming into play. The international focus on HIV/AIDS seems
to be less a result of a concern about public health, than it is
about Western nations using the issue as a way to justify more intervention
into, and control over, African societies. The tone of the discussion
was set by a draft document, The Declaration of Commitment on HIV/AIDS,
prepared by the session's co-facilitators, ambassador Penny Wensley
of Australia and ambassador Ibra Deguène Ka of Senegal:
'Noting with grave concern that Africa, in particular Sub-Saharan
Africa, is currently the worst affected region where HIV/AIDS is
considered as a state of emergency, which threatens development,
social cohesion, political stability, food security and life expectancy
and imposes a devastating economic burden and that the dramatic
situation on the continent needs urgent and exceptional national,
regional and international action.' (13) The only hint at controversy
during the three-day session erupted over the question of whether
prevention or treatment should be the main focus of international
efforts against the disease. Declarations and statements from the
donor countries - the rich Western nations - indicated a preference
for money being spent on AIDS prevention rather than retroviral
Understandably, with Sub-Saharan African leaders being told that
22million of their citizens are already infected and that their
economies will collapse and their society descend into anarchy as
these people become sick and die, African leaders expressed a desire
for free retroviral drugs.
The argument over treatment v prevention provided some exposure
of the political agenda behind the meeting. In one of the few outright
derogatory comments, Andrew Natsios, head of the Agency for International
Development, told the Boston Globe that Africans lack the concept
of time required to take a complicated regime of retrovirals and
that, therefore, most money should go towards prevention and not
cure (14). His comments caused a predictable storm of condemnation,
with letters declaring him a racist and calling for him to be sacked.
Very little of what is happening has to do with saving lives
in Africa or anywhere else.
It was the New York Times, however, that set Natsios straight.
An editorial argued that treatment should be made available to Africans
because, 'the availability of treatment gives people a reason to
get tested for AIDS and draws them into a health clinic, where they
can learn how to practice safe sex' (15).
It is apparently okay to suggest blackmailing Africans into attending
a clinic for treatment and ambushing them with a condom and a banana
- as long as you don't suggest that they are too stupid to use a
watch. So long as you get the language right, it seems that safe
sex is the new politically correct way to push Africans around.
African heads of state who are prepared to pepper their populations
with moralising messages about sex, civil liberties and treatment
of women are lauded by those in the West - but heaven help those
who haven't quite twigged the new sexual order. Colin Powell put
it bluntly, citing President Yoweri Musevini of Uganda as his example:
'[Musevini] says "This is what is causing it…irresponsible
heterosexual sex." It kind of jars when you hear it but that
is the kind of leadership message that has to be given.'
Other world nations are encouraged to follow suit by providing AIDS
education to children: 'drilling it into them just like we do here
with anti-smoking and other types of campaigns.' (15) (Sadly, African
leaders forgot to ask Powell just how successful that anti-smoking
campaign has been, and why on Earth he thinks it might work in their
The session ended with publication of a document: The Declaration
of Commitment, which calls for nations to 'address the epidemic
in forthright terms; confront stigma, silence and denial; address
gender and age-based dimensions of the epidemic; eliminate discrimination
and marginalisation' (16). Such statements suggest more of an attack
on societies' values than an attack on a disease. Dr Peter Piot,
executive director of UNAIDS, called the document an 'instrument
for accountability'. Countries will be pushed to put cultural mores
aside. 'It is our job to push the edges now', said Dr Piot (17).
At one point the declaration makes clear that 'harmful traditional
and customary practices' should be eliminated, and Kofi Annan told
the press that the United Nations will follow countries to ensure
they are setting and meeting the targets of the declaration. Those
that are failing will be 'chastised' (18).
As a result of this discussion, African populations are being coerced
into seeing themselves as the victims of their own backwardness
and African leaders encouraged to act as if they are liberals living
in Southern California. They are supposed to let it all hang out
in public, talking about condoms and shagging on the radio and TV.
Men will be taught to respect women, to abandon their old-fashioned
views of patriarchy and stop visiting brothels. Members of the armed
forces will be nice to the wives of the husbands they are killing.
The police will take a more active role in pursuing rapists, the
state will clamp down on child abuse, and courts will become woman-
The virtues of fidelity will be championed and the population warned
of the dangers of mixing alcohol with one-night stands. Women will
be taught about the use of female condoms and how to enjoy using
one. If all this still fails to change behaviour, then people may
be manoeuvered into counselling and testing. Counselling centres
could be set up in the workplace, on the farm and in schools, and
employment made conditional upon attendance.
Safe sex is the politically correct way to push Africans
All of these ideas are to be found within the pages of the UNAIDS
report on the global HIV/AIDS epidemic (19), and variations on the
theme were ever-present during the UNAIDS special session. No aspect
of life is to be untouched in the developing world. From the classroom
to the bedroom to the workplace to the courts to the army, all will
be interfered with and encouraged to reform under the banner of
eliminating HIV and encouraging safe sex.
No doubt many will say that attempts by Western nations to alter
African behaviour are justified if it saves the continent from collapse.
But this badly misses the point. Western governments used the AIDS
issue to moralise to their own populations, regardless of the facts
or health benefits - and it seems likely they will try to adopt
the same tactics abroad (20). Very little of what is happening has
much to do with saving lives in Africa or anywhere else.
The hysterical expectations of African disaster have little basis,
but they encourage the notion that African nations cannot approach
their health problems using their own ideas and plans. Even though
Africans are where it is happening, and although there is little
reason to expect that an intervention useful in New York City to
have any relevance on the African Savannah, the only interventions
likely to be put into action will have their motivation anywhere
but in Africa. The consequence will be a creeping but definite controlling
reach from the outside in, with African sovereignty and independence
If Western nations really wanted to be helpful they could cancel
third world debt, refrain from complicating the internal politics
of Africa through interference, provide medicines, and provide money
to develop clean water supplies and efficient farming, industrial
and pharmaceutical practices. This is so far from not happening
that it is just not funny. The proposal to cancel third world debt
has been around for decades but carries so many strings that in
practice, if it ever happens, many countries might be better off
keeping the debt.
Medicines that could right now save millions of lives are not provided
and have not been for decades. There is little reason to expect
this to change, and the advanced industrial practices of the West
are jealously guarded from the developing world lest they start
to cut into profits at home.
UN secretary general Kofi Annan has said that the global fund for
AIDS and health needs to raise $7billion to $10billion to be effective.
But enthusiasts for the campaign against AIDS in Africa seem less
keen when it comes to hard cash. Bill Gates stated that, 'there
is no higher priority than stopping transmission of this deadly
disease', before pledging $100million to the fund. (21). The USA
could barely do better than the Gates Foundation with a pledge of
$200million, widely expected to be provided at the cost of other
aid programs. The UK pledged $100million, but then the UK is quite
possibly less well off than Bill Gates. Coca-Cola, Volkswagen and
Daimler Chrysler have also pledged money and assistance. In a move
bound to produce disappointment, Coke trucks will apparently be
used to deliver condoms instead of soft drinks.
If Africa is lucky, Kofi Annan will get no closer than the current
$500million or so - but I suspect that once word gets around that
the AIDS fund will be used to bring Africa to heel, the donations
will start to pour in.
Twenty years into the AIDS pandemic and the one thing that is still
sorely missing is a detached scientific enquiry. Development of
effective treatments and a vaccine would, if made available, be
of enormous benefit to Africans and everyone. In the meantime, epidemiological
investigations that reported disease trends without resorting to
hyperbole and that located the reasons for different patterns around
the globe might provide important insights into the disease.
An honest appraisal of breakthroughs and trends absent of the ideology
and politicking that inevitably follows AIDS is to be encouraged.
AIDS is not the wrath of God, nature's revenge or the new bubonic
plague; it is a nasty infectious disease that requires clear thinking
and investigation to overcome. Bill Gates should stick to building
computers and Coke to delivering Coca-Cola, while those that may
provide real assistance do their work unhindered.
The AIDS panic in perspective, Dr Michael Fitzpatrick
Dr Stuart Derbyshire is a contributor to Animal
Experimentation: Good or Bad?, Hodder & Stoughton, 2002. Buy
this book from Amazon (UK)
(1) New York Times, 19 June 2001
(2) Download the The Global Strategy Framework on HIV/AIDS in .pdf
(3) New York Times, 20 June 2001
(4) New York Times, 26 June 2001
(5) Derbyshire, S.W.G. (1995) 'Duesberg and AIDS', Nature, 377,
672; Derbyshire, S.W.G. (1996) 'Infectious AIDS: Have we been misled?'
British Medical Journal, 312, 1236; Derbyshire, S.W.G. (1997) 'Those
who believe in alternative theories of AIDS have little room to
maneuver', British Medical Journal, 314, 607-608
(6) 'WHO criticized for "inflating" AIDS figures, AIDS
Analysis Africa, December 1995: 4-5. 'AIDS is less of a health threat
than other diseases in Africa', British Medical Journal 1995; 311:
(7) Weekly Epidemiological Record, 26 July 1994; Guardian, 17 November
(8) Report on the global HIV/AIDS epidemic, June 2000
(9) WHO factsheet No 112
(10) Epidemiological Fact Sheet: Mozambique - 2000 update (.pdf
(11) Epidemiological Fact Sheet: Nigeria - 2000 update (.pdf format)
(12) Population statistics
(13) UN declaration of commitment on HIV/AIDS
(14) Boston Globe, 7 June 2001
(15) New York Times, 24 June 2001
(16) Revised Draft Declaration of Commitment on HIV/AIDS, 11 May
(17) New York Times, 28 June 2001
(18) New York Times, 28 June 2001
(19) Report on the global HIV/AIDS epidemic, June 2000
(20) The AIDS panic in perspective, Dr Michael Fitzpatrick
(21) New York Times, 19 June 2001
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