Report predicts 20 million AIDS orphans in Africa by 2010

BMJ 2003; 327 doi: http://dx.doi.org/10.1136/bmj.327.7426.1245 (Published 27 November 2003)
Cite this as: BMJ 2003;327:1245.1

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It's two years after the estimates were made, are there studies that report the current information on the number of AIDS orphans in Africa? The decrease in prevalence figures of HIV/AIDS are they not impacting on the numbers?

Competing interests: None declared

Jephat Chifamba, Senior Lecturer

University of Zimbabwe College of Health Sciences, MP167 Mount Pleasant Harare

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As an international ambassador for the British Charity Action Aid, actress Emma Thompson has taken time out this year to propagate the 'HIV' myth in Uganda and Mozambique, but both countries have no 'HIV' or 'AIDS' epidemics.

TB and malaria in Uganda are being cynically re-marketed as 'AIDS' in order to promote and sell highly cytotoxic (so-called) 'anti-retroviral' drugs. With perfect sincerity, Emma Thompson is unwittingly trying to put out a fire by throwing petrol on it. This highly intelligent woman needs to be more critical and less emotional in her assessment of what so-called 'AIDS' really is. Thompson has also to question the validity of the non- specific 'HIV' tests: over 70 conditions are known to make these invalid tests rum positive - including TB and malaria.

How can so-called 'anti-retroviral drugs' cure immunodefiency caused by long-term malnutrition and poor sanitation, etc, which have allowed endemic diseases (such as TB and malaria) to reach epidemic proportions in parts of Africa?

Indeed, there is growing doubt about the very existence of 'HIV'. "I realized that the whole group of viruses to which HIV is said to belong, retroviruses ...in fact do not exist at all. I was wondering what viruses are for... in evolutionary biology and found that ...every one of our genomes, and that of higher plants and animals, is the product of so- called reverse transcription: RNA transcribed into DNA.." Stefan Lanka Ph.D.interviewed in Zengers magazine Dec 1998.

The new science of micro-RNAs (see 'RNA Trades Bit Part for Starring Role in the Cell'by Andrew Pollack, The New York Times, January 23rd 2003) also throws in to doubt the very existence of all 'retroviruses'. Certainly, the standard works on 'retroviruses' are filled with inaccurate science; for example when retroviral particles cannot be seen in diseased tissues, scientists use non-specific 'markers' to infer the presence of an alleged 'retrovirus' (like 'HIV'). Retrovirologists cannot see the putative 'HIV' - but they 'know' it is 'there'! This is not science: this is theology. Retrovirology is Theology; gnosis is not science.

For BBC News, Emma Thompson stated to Jesse Crowder: "The only way you can get Aids is through the sexual excretions - through the conjoining of your body sexually, through either orifice."

This absurd myth making is pure supposition totally unsupported by any scientific evidence: 'HIV' have never been recovered, visualised, isolated from any fresh sample of semen or blood taken directly from an 'AIDS' patient.

As Etienne De Harven, MD, (Emeritus Professor (Pathology), University of Toronto, and Member of the South African Presidential AIDS Advisory Panel, France), stated recently:

"Current policies for helping Africa in what has been described as the AIDS crisis, are entirely based on the validity of the HIV=AIDS hypothesis. However, this hypothesis must be completely reappraised because HIV has never been isolated nor purified, directly from AIDS patients, in a way that would satisfy the classic requirements of virology. More specifically: 1) HIV particles have never been demonstrated by electron microscopy in the blood stream of AIDS patients allegedly presenting with high ' viral load '. 2) Alleged HIV isolations have been reported, based on the identification of molecular 'markers'. These markers are of physical, biological or genetic nature. Their HIV specificity could never be rigorously demonstrated because such demonstration would have necessitated HIV purification that has never been achieved. 3) Serological tests for so-called 'HIV seropositivity', being based on the same non specific markers, also lack specificity and do not demonstrate any HIV infectious process. 4) Public credulity is abused by the constant publication of HIV images that all derive from electron microscopy of laboratory cell cultures, and never derive directly from AIDS patients. In view of these major uncertainties concerning HIV isolation directly from AIDS patients, priorities should be drastically revised. Suspending all HIV sero-testing, and suspending administration of anti-retroviral toxic medications should make budgets available to combat malnutrition, extend drinking water distribution, and improve hygiene and sanitation for the African people." ('Problems with isolating HIV' , European Parliamnet Conference on AIDS in Africa, Brussels, December 8, 2003).

Competing interests: None declared

Competing interests: None declared

Alexander H Russell, Writer/artist

WC1N 1PE

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EUROPEAN PARLIAMENT CONFERENCE ON AIDS IN AFRICA Brussels, December 8, 2003

A BRIEF REPORT

Written by Roberto Giraldo and edited by Sam Mhlongo, Etienne de Harven, Christian Fiala, Marc Deru and Gordon Stewart. Please note that much of this report was translated from various languages.

1. BACKGROUND

Marc Deru, a physician and nutritionist from Belgium and a long-term member of Rethinking AIDS, proposed that the Environment Commission of the European Parliament convene a debate on AIDS in Africa between representatives of the HIV/AIDS mainstream and AIDS dissidents. Paul Lannoye, coordinator of the Commission, who was aware of AIDS dissidence through the work of Mark Griffiths, determined that the AIDS dissidents' arguments were sufficiently substantive to merit a conference, a determination that was accepted by the European Parliament. Due to budget constraints Mr. Lannoye limited the invitations to eleven speakers. Each speaker was allotted 25 minutes and there were also four 30-minute sessions allotted to debate. The conference was attended by approximately 150 people from several European and African countries.

2. GOALS OF THE CONFERENCE

In the invitation to speakers Mr. Lannoye stated: "I am taking the initiative to organize at the European Parliament in Brussels on the 8th of December a symposium on the political priorities of sanitary assistance in Africa facing the AIDS epidemic. The symposium is designated to inform my Parliamentary colleagues, development NGOs and other actors who work in this issue. After the controversial position of the South African President Thabo Mbeki, I thought that it was necessary to present different points of view on this issue, in a constructive and non polemic dialogue."

3. PROGRAM

3.1. "Welcome. Opening of the Conference and introduction." Paul LANNOYE, Member of the European Parliament, Belgium.

3.2. "AIDS: A development crisis." Michel SIDIBE, Director, Country and Regional Support Department, UNAIDS, Geneva, Switzerland.

Sidibe presented an apocalyptic description of the AIDS epidemic in Africa, emphasizing that the primary solution is antiretrovirals: "Nearly 27 million are now living with HIV (in Africa), more than 15 million are already dead from AIDS, and more than 11 million children have lost at least one parent to the epidemic"; "In 2005, as the virus spreads farther and kills more people, it is estimated that US $5 billion will be needed"; "In South Africa, an estimated 17% of primary health-care workers are infected with HIV"; "Why is Africa denied the medicines widely available in wealthier countries?"; "The present supply of condoms in Africa, where the epidemic is overwhelmingly driven by sexual transmission, amounts to approximately three condoms per year for each adult male. About 70,000 Africans - out of more than 4 million in need - have access to antiretroviral treatment. Only 1% of HIV-positive, pregnant African women receive treatment to prevent the spread of the virus to their unborn children"; "We can no longer embark on development or humanitarian assistance that does not mainstream HIV/AIDS prevention and treatment"; "Prevention slows the spread of HIV, and antiretroviral treatment blunts the impact of AIDS"; "Sadly, the donor response to the UN Consolidated Appeals for the region in 2002 and 2003 was overly focused on meeting the food needs, rather than addressing the underlying causes of the crisis." He was gratified to state that: "The World Food Programme recently became the ninth Cosponsor of UNAIDS, and WFP Executive Director James Morris later announced that the organization is shifting its aid in Southern Africa from providing traditional emergency food aid to providing HIV/AIDS -related assistance."

3.3. "External European Parliament policy on AIDS." Poul NIELSON, Member of the European Parliament, Coordinator of the Commission on development and humanitarian aid, Belgium.

Mr. Nielson explained in some detail the external European Parliament policy on AIDS, which is based on the mainstream HIV/AIDS paradigm. Information concerning these policies may be viewed at: http://europa.eu.int/comm/development/body/csp_rsp/csp_en.cfm http://www.un.org/millenniumgoals/ http://europa.eu.int/eur-lex/en/com/cnc/2001/com2001_0096eno1.pdf http://europa.eu.int/eur-lex/en/com/cnc/2003/com2003_0093eno1.pdf

3.4. "European Parliament position concerning the struggle against AIDS." Didier ROD, Member of the European Parliament, France.

Mr. Rod explained, in detail, the European Parliament position concerning the struggle against AIDS, which is also based on the mainstream HIV/AIDS paradigm. Both Mr. Nielson and Mr. Rod, members of the European Parliament, emphasized that the salvation of Africa is through the use of antiretrovirals as tools for prevention and treatment.

Discussion 3.5. "Public Health issues and the role of medicine in South Africa." Prof. Sam Mhlongo, MD, Chief Specialist Family Physician & Head of The Department od Family Medicine at The Medical University of Southern Africa; Member of the South African Presidential AIDS Advisory Panel, South Africa.

"The aims of this presentation were to remind and educate on South African history - in particular a focus on the history of health disabilities and disadvantages suffered by the African people under Apartheid. It was also the aim to compare and contrast Apartheid South Africa with present South Africa - in other words, we now have political freedoms but we are still far away from economic freedoms and self- reliance. In the introduction, the international lie that President Mbeki has stated that HIV is not the cause of AIDS was nailed - there is no such record. His two questions however remain unanswered: Why is AIDS in Africa so vastly different from AIDS in Europe and North America? Why does AIDS in Europe and North America remain largely confined to the same groups in which it was initially described - i.e., intravenous drug users and the gay community?" "Nutritional AIDS dominates the scene in South Africa today as indeed it did during Apartheid. In the middle 50's and 60's, 50% of black children were dead before the age of 5. The causes of death were recorded as: PNEUMONIA, HIGH FEVER, DEHYDRATION and intractable DIARRHOEA due to protein deficiency. Today, these clinical features are called AIDS. Today in South Africa, TB is the leading cause of death and morbidity amongst Africans, but this is called AIDS. In conclusion, NUTRITIONAL AIDS is a direct result of Apartheid in association with capitalist iatrogenesis - hence the shacks (favelas), lack of sanitation, lack of clean drinking water, unemployment and destitution."

3.6. "Update on Uganda, an analysis of the predictions and assumptions about the former epicentre of the AIDS epidemic - implications for other African countries." Christian FIALA, MD, Specialist in Obstetrics and Gynecology, Member of the South African Presidential AIDS Advisory Panel, Austria.

"We are still subject to news and predictions about a very high death toll in the current Aids epidemic in Africa that is beyond imagination. However, the claim of such a high number of deaths is based on estimates and certain assumptions. It seems essential to substantiate these claims before asking for wide ranging interventions. The case of Uganda provides an important lesson in this respect. A detailed analysis seems mandatory before engaging in costly and potentially dangerous interventions in other African countries like South Africa. The absence of the predicted Aids catastrophe in Uganda calls the basic assumptions about the epidemic into question. It is high time to reconsider the priorities of health policy and foreign aid." The full article can be viewed on the website of the British Medical Journal, under rapid responses: http://bmj.bmjjournals.com/cgi/eletters/327/7408/184-a#35837

3.7. "Tanzania, region Kagera, the AIDS epicentre in Africa 15 years ago: what is the current situation? Two months of observations in the field." Marc DERU, MD and Nutritionist, Member of the Group for the Scientific Reappraisal of AIDS, Belgium.

"In Tanzania, the population of the Kagera region, epicentre of AIDS 15 years ago, hasn't ceased growing since then, i.e., with a 53% increase between 1988 and 2002. The demographic catastrophe expected as a result of the 'deadliest epidemic in history' did not materialize, on the contrary. Yet, no real, concrete anti-viral measures were applied in the region. The only explanations for this lie in the improvement in the economic conditions and in development aid. An example of a global approach to development is found in the NGO, Partage Tanzania. While the experts, with their statistics, would have one believe that there exists an extremely serious HIV/AIDS epidemic, no trace of an epidemic is observable in the field. All that can be seen is a very poor, under-nourished population suffering from malaria, endemic immunodeficiency and common illnesses. The so-called 'HIV' tests are unspecific; the positive results they may give are misleading and lead to the false belief in the existence of a viral epidemic. Common sense and scientific reason dictate their abandonment as well as a return to the objectivity of clinical diagnosis and to the treatment of clinically visible illnesses, all of which have been known for a long time. The facts very clearly demonstrate that the endemic African immunodeficiency has nothing to do with a hypothetical 'HIV', but is, rather, the result of malnutrition and its corollaries. In order to provide effective help to Africa, the priority should be given to the eradication of the overly great poverty which exists there." English version : http://www.altheal.org/texts/tanzania.htm French version : http://www.sidasante.com/edh/isolvih.htm

Discussion 3.8. "Problems with isolating HIV." Etienne DE HARVEN, MD, Emeritus Professor (Pathology), University of Toronto, Member of the South African Presidential AIDS Advisory Panel, France.

"Current policies for helping Africa in what has been described as the AIDS crisis, are entirely based on the validity of the HIV=AIDS hypothesis. However, this hypothesis must be completely reappraised because HIV has never been isolated nor purified, directly from AIDS patients, in a way that would satisfy the classic requirements of virology. More specifically: 1) HIV particles have never been demonstrated by electron microscopy in the blood stream of AIDS patients allegedly presenting with high ' viral load '. 2) Alleged HIV isolations have been reported, based on the identification of molecular 'markers'. These markers are of physical, biological or genetic nature. Their HIV specificity could never be rigorously demonstrated because such demonstration would have necessitated HIV purification that has never been achieved. 3) Serological tests for so-called 'HIV seropositivity', being based on the same non specific markers, also lack specificity and do not demonstrate any HIV infectious process. 4) Public credulity is abused by the constant publication of HIV images that all derive from electron microscopy of laboratory cell cultures, and never derive directly from AIDS patients. In view of these major uncertainties concerning HIV isolation directly from AIDS patients, priorities should be drastically revised. Suspending all HIV sero-testing, and suspending administration of anti-retroviral toxic medications should make budgets available to combat malnutrition, extend drinking water distribution, and improve hygiene and sanitation for the African people." During his presentation de Harven acknowledged several times that the Perth Group, led by Eleni Papadopulos- Eleopulos, was the very first to question the isolation of HIV. English presentation : http://www.altheal.org/texts/isolhiv.htm French presentation : http://www.sidasante.com/edh/isolvih.htm The Perth Group : http://www.theperthgroup.com & http://www.virusmyth.net/aids/perthgroup

3.9. "The essentials for HIV/AIDS prevention are: preventing medical transmission, warning about anal intercourse, and redirecting research." Stuart BRODY, PhD, Clinical Psychologist, University of Tubingen, Germany.

Dr. Brody is a member of the David Gisselquist group that has published several papers during the last year questioning sexual and vertical transmission of HIV/AIDS in Africa. The group has suggested that medical or iatrogenic transmission through unclean injections in Africa may be the explanation for "HIV infections" in the continent. With the intent of censoring their views, UNAIDS and WHO held a meeting with these researchers in March, 2003, and released a declaration stating: "An expert group has reaffirmed that unsafe sexual practices are responsible for the vast majority of HIV infections in sub-Saharan Africa, and that safer sex promotion must remain the primary feature of prevention programmes in the region." We had the opportunity to congratulate Dr. Brody for the courage of his group in criticizing the sexual and vertical transmission of HIV/AIDS. We also explained to him that the only thing that is being "transmitted" from person to person in Africa is the consequence of decades and decades of poverty.

3.10. "Access to treatments in Africa: choosing between necessity and constraints." Prof. Nathan CLUMECK, MD, Director, Department of Infectious Diseases, CHU Saint-Pierre (ULB), Belgium.

It was Dr. Clumeck who described, in March 19, 1983 (Lancet) and February 23, 1984 (NEJM), the clinical manifestations and laboratory findings of the very first 23 black Africans who were diagnosed with AIDS in Brussels. In spite of acknowledging the severe toxicity of antiretrovirals, he promotes their use for the treatment and prevention of AIDS in Africa: "With the generalization in 1995 of the triple antiretroviral therapy, the prognosis and the natural history of HIV infection has changed...Currently 4 to 5 million Africans desperately need antiretroviral treatment, however, only 50 to 60,000 are getting it." Clumeck is content with the efforts regarding the HIV/AIDS crisis in Africa promoted by the World Bank, the Bill and Melinda Gates Foundation, and the Clinton Foundation, as well as with the aid from charismatic leaders like Nelson Mandela. He noted Botswana as an example to be followed, since there, "thanks to the efforts of the Gates and Merck Foundations, everybody has access to free antiretroviral treatment."

Discussion

3.11. "Treating and preventing AIDS: basic principles for an effective, nontoxic and inexpensive alternative." Roberto GIRALDO, MD, specialist in internal medicine, infectious and tropical diseases, USA. Member of the South African Presidential AIDS Advisory Panel.

"The core of this presentation is to explain the scientific bases for the use of food supplements, antioxidants, and immune stimulants as a non toxic, effective, and inexpensive alternative for the treatment and prevention of AIDS everywhere. Nutritional deficiencies and oxidative stress play a major role in the pathogenesis of AIDS. Nutritional supplements and antioxidants prevent the progression of 'HIV-positive' individuals into the clinical manifestations of AIDS; prevent the death of patients who already have the clinical manifestations of AIDS; and prevent the seroconversion of HIV-negative individuals, of all ages, into 'HIV- positive.' This last means that what is known as 'transmission of HIV/AIDS' can also be effectively prevented by the use of food supplements and antioxidants. If we really want to solve the issue of AIDS in Africa, it is mandatory that we first solve poverty and its consequences." Details on these views may be seen at: http://www.robertogiraldo.com/eng/papers/TreatingAndPreventingAIDS.html http://www.robertogiraldo.com/eng/papers/NutritionalTherapy_SADC_2003.html Giraldo proposed to Dr. Michel Sidibe, the UNAIDS representative at the European Parliament conference, to have an open debate with AIDS dissidents upon the causes and solutions for AIDS at the Bangkok International AIDS Conference in July 2004. Dr. Sidibe gave Giraldo his word that this debate would be programmed.

3.12. "The struggle against AIDS in Africa: Research contribution." Luc MONTAGNIER, President of the International Foundation for the Research and Prevention of AIDS, France.

He stated: "Thanks to scientific research the virus that causes AIDS was isolated." He then explained what is purported to be the "pathogenesis of the HIV infection," and presented several clues concerning "HIV/AIDS vaccine possibilities." He placed a strong emphasis on oxidative stress as being the cause of apoptosis of CD4 cells. He also acknowledged that even "HIV-negative" Africans have oxidative stress due to malnutrition. He proposed the use of antioxidants and immune stimulants together with three antiretrovirals for the prevention and treatment of "HIV/AIDS." He showed several computer-generated, colorized pictures of "HIV" and of "the pathogenesis of HIV-infection."

Discussion 3.13. Conclusions Paul LANNOYE, Belgium.

NOTE: Some of the other AIDS dissident researchers and activists who attended the conference and participated actively during the discussions were: Claus Koehnlein, MD (Kiel, Germany), who also distributed to the attendees his recent paper, co-authored with Peter Duesberg and David Rasnick, "The chemical bases of the various AIDS epidemics: recreational drugs, anti-viral chemotherapy and malnutrition"; Gordon Stewart, MD (Glasgow, Great Britain), who asked Luc Montagnier "whether, in the light of the report from de Harven, he was sure that they had indeed 'Isolated' a retrovirus named by them as LAV-BRU from a co-culture of a lymph gland from a patient in Paris in 1983 by standard virological techniques. My recollection is that he responded to my question but did not answer it." Also present were: Juliane Sacher, MD (Germany); Neville Hodgkinson, journalist (England); Djamel Tahi, writer (France); James Whitehead, NGO activist (England); Mark Griffiths, NGO activist (France). Shabnam Merchant and Joanna Choy, student documentary filmmakers from New York City, also attended the conference.

4. FOLLOW UP

Mr. Lannoye and his assistant, Ms. Francoise Dupont, stated during the preparation stage of the conference: "In order to extend the awareness of the public about this debate, we would like to publish the proceedings of the conference." After the Conference Mr. Lannoye wrote to us: "I wanted to thank you very much for your participation at the conference 'AIDS in Africa' that took place on December 8th in the European Parliament. Indeed, everyone agrees that the conference was a success: beyond the fact that the audience was very numerous, the quality of the interventions we listened to was very high and the debate, that we hoped would be contentious, allowed for every position to be expressed in a relatively civil atmosphere. My objective now is to ensure that there is a follow up of this conference. Apart from the strictly political follow up, I want to publish the extensive proceedings of the conference as well as the debate, which largely contributed to a better understanding of the question. The publication should allow for the debate to continue outside the European Parliament." South African Presidential AIDS Advisory Panel Experiments: At the meeting Professor Sam Mhlongo made an appeal to the chairman that he consider some way of finding some money to help The Panel Experiments. Professor Mhlongo has confirmed that Mr. Lannoye has followed this up and has asked him to summarize the ten experiments and the budget for them. Professor Mhlongo is doing so and if this does come off, the money President Thabo Mbeki has allocated to the experiments can be diverted to a "Poverty Relief Programme" shortly after the general election in South Africa in 2004.

For a less rigourous synthesis of this meeting, read Mark Griffiths' "Some personal comments on the "AIDS in Africa" forum" : English : http://www.altheal.org/events/mgepcomments.htm French : http://www.sidasante.com/critique/mgepcom.htm

Competing interests: None declared

Competing interests: None declared

Alexander H Russell, Writer/artist

WC1N 1PE

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The problems with HIV/AIDS will never be completely successfully treated until we address one of THE ubiquitous underlying health concerns which come from the MOUTH. There are 400 PLUS different, potentially virulent microorganisms living in the mouth. Collectively there are BILLIONS of them in and around the teeth and gums. In the mouth of a person who lives in poverty, drought and resulting malnutrition, combined with poor oral hygiene they will cause a chronic bleeding, inflammation and teeth/gums infection. This sets up an chronic immune response which over time becomes exhausted, weakens the body and then increases susceptability to opportunistic infections of many types of bacteria, viruses and fungi. In addition, research has proven that the infections in the mouth are transmissible to other susceptible people. No amount of drugs or vaccines will help with the availability of clean water and with nutritious crops/foods on the table to repair cells and maintain a sound immune system. No drugs or vaccines will create a clean household environment for living a healthy life. No amount of drug and vaccines will put a toothbrush in the hand to keep the mouth germs from growing and harming the health of the mouth and overall body. Powerful drugs more than often will put an additional burden on an already malnutrition-affected body. Add to that the burden of a chronic infection in the mouth, and a good, long-lasting healing ability will be seriously reduced. Sugar loaded modern foods and drinks add an other serious burden to bodies that really need good nutrition to restore and permanently maintain good health. We need to inform people and doctors alike of the dire need to get back to the cheaper basics of living properly to not become a victim of always present and opportunistic germs. And, we need to rely less on expensive and potent drugs with their often harmful side-effects.

Competing interests: None declared

Competing interests: None declared

Pieter van Harencarspel, Professor of Health and Nutrition

University of Mexico

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A study published in The Lancet(1) found that:

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"Among 460 patients with pulmonary tuberculosis, the overall mortality rate was significantly higher in HIV-positive than HIV-negative persons"

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In fact those with HIV and TB were 17 times more likely to die than those with just tuberculosis.

***

References:

(1) Ackah AN, Coulibaly D, Digbeu H, Diallo K, Vetter KM, Coulibaly IM, Greenberg AE, De Cock KM. Response to treatment, mortality, and CD4 lymphocyte counts in HIV-infected persons with tuberculosis in Abidjan, Cote d'Ivoire. Lancet. 1995 Mar 11;345(8950):607-10. PMID: 7898177 http://www.ncbi.n lm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7898177&dopt=Abstract

Competing interests: None declared

Competing interests: None declared

Tony Floyd, Medical Student

Newcastle University, Newcastle Australia

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It is distressing that 20 years after the discovery of HIV-1, unsubstatiatable claims that it is not the causative agent of AIDS persist.

It is dangerous nonsense to propogate theories that HIV does not cause AIDS. Dangerous, because it denies the importance of life-enhancing and life-prolonging anti-retroviral therapy, in addition to undermining attempts to prevent spread of HIV. Nonsense, because it has been demonstrated beyond reasonable doubt that: 1) HIV causes depletion of T cells. 2) Depleted T cells results in immunodeficiency which when severe enough is termed AIDS. 3) Treating HIV with anti-retroviral drugs suppresses the viral burden, reverses immunodeficiency and dramatically improves prognosis. 4) AIDS is most prevalent where the highest HIV seroprevalence rates are.

I agree wholeheartedly that trying to tackle the problem of AIDS by focusing solely on HIV is a blinkered approach. Fundamental to any solution of HIV/AIDS in Africa is the recognition that developmental assistance to restore some degree of medical, social and economic parity must go hand in hand with effective HIV education, prevention and treatment programs.

But attempts to stop AIDS without stopping HIV are doomed to fail.

Paul Robertson, MRCP

Competing interests: PR is involved in research investigating means by which HIV causes AIDS

Competing interests: None declared

Paul Robertson, Research Fellow

AIDS Research Center, Harvard Medical School, Boston MA, 02129

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I agree with you that indigenous diseases, such as TB, malaria, chronic fevers, malnutrition weight loss and illnesses associated with poverty contribute to the numbers. But, you fail to note that such things are tightly related one with each other, including HIV spread. Sub-Saharan Africa is victim of extreme poverty in the first place, and that summed with low literacy, poor educational access, inadequate infrastructure, lack of fresh water, all brings about the fall of an entire system that cannot cope with the population demands and needs in all aspects.

Healthcare is a mayor aspect, as you may know, it becomes extremely difficult and sometimes impossible to successfully get health policies to practice, delivering drugs, screening population, recording diseases to name some. In developed countries such pandemics are better controlled, because the aspects I mentioned are not base problems to solve.

And about sexual behaviour in the population, besides the existence of communities or tribes with conservative sexual practices they would never acount for the nearly 30 millon HIV/AIDS cases estimated. They live in a high retroviral prevalence zone. Sadly, condoms are not easily available in Botswana, Lesotho, and Swaziland. Most of the population, because of lack of education would not consider the risks of unsafe sex, they live completely isolated and unaware.

So, it seems to me that removing ´HIV´ from the equation will not solve the problem. Instead, perhaps, including education and heath care reach would be more useful and sure make a difference.

Competing interests: None declared

Competing interests: None declared

J Pablo Orezzoli, Ob/Gyn Resident

Hospital de Clinicas

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1 December 2003

The headline: "Report predicts 20 million AIDS orphans in Africa by 2010" is pure science fiction. The definitions of so-called 'AIDS' in Africa are amorphous, nebulous and opaque. What we are calling 'AIDS' in Africa is the cynical relabelling and remarketing of long established, indigenous diseases, such as TB, malaria, chronic fevers, malnutrition weight loss and illnesses associated with poverty and which have nothing to do with the hypothetical and non-isolated 'HIV'.

Why is it that the putative 'HIV' should allegedly spread like wildfire in Africa, Russia or China but not in the USA or Europe? If 'HIV' really were an STD it would not have restricted itself rigidly and dogamtically to the original high risk groups for over twenty years. Why is 'HIV' so prejudiced against white heterosexuals in the West? It is also known that in Africa many communities and tribal groups are very strict and conservative in their sexual practices while in the West we are far more promiscuous. So how can 'HIV' be an STD? In the UK we have had a recent high rise in teenage STD rates but no 'HIV' epidemic amongst teenagers. So how can 'HIV' be an STD? It is not 'HIV' that is spreading but the use testing kit.

We still have this rather unscientific post-colonialist racist fantasy of 'wild savages' have sex orgies in Africa. This is all racist retrovirology. We must ask ourselves what are the specific illnesses people are really dying from in Africa: TB, malaria, conditions relating to poverty - ? When someone is allegedly dying from 'AIDS' we must ask ourselves: what are the real terminal presenting illness and forget 'HIV' which constantly obfuscates and mystifies the true origins and causes of illnesses. We will only begin to solve 'AIDS' once we have removed 'HIV' from the equation.

Alex Russell MA,

London WC1N 1PE

Competing interests: None declared

Competing interests: None declared

Alexander H Russell, Writer/reviewer

WC1N 1PE

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30 November 2003

Sir

The article by Fiona Fleck correctly points out the desperate situation that faces many sub-saharan African children today. At least a third of adults in sub-Saharan Africa will die of TB, and it is well known that TB and HIV work hand in hand in creating such orphans. I note that the parents of the orphan featured, died of AIDS-related TB. However, unlike HIV, TB treatment has been declared by the World Bank as one of the most cost effective strategies available. It is absolutely imperative that we place political pressure to ensure adequate supply of drugs, diagnosis and then ensure long term compliance with TB treatment in such countries. This is no mean task, but by ensuring effective TB strategies would reduce the transmission of TB to HIV positive adults, and buy time for many young Africans. This would make a significant economic and social impact in sub-Saharan Africa.

Competing interests: Trustee, TB Alert

Competing interests: None declared

Caris E Grimes, 5th year medical student

St Bartholomew's and the Royal London School of Medicine

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