Education And Debate

Reframing HIV and AIDS

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7423.1101 (Published 06 November 2003) Cite this as: BMJ 2003;327:1101

HIV/AIDS is indeed a colossal catastrophe

Dear Editor,

The article "Reframing HIV and AIDS" says "In just over two decades,
the epidemic has already killed over 23 million people" and cites "UNICEF.
HIV/AIDS: The big picture 2003" as the source. UNICEF also says that over
40 million people are living with HIV/AIDS. Where do these numbers come
from? South African author Rian Malan went in search of the source of
these frightening numbers and recorded his findings in 2001 where he
documented the lack of evidence for claims of an AIDS emergency in Africa
(1).

If AIDS is indeed devastating and depopulating Africa and other parts
of the world then there should be hard evidence that would slap anybody in
the face and wouldn't need to read about it in BMJ and the New York Times.
People in the Middle Ages new all about the Plague without the benefit of
a CDC, WHO, NIH, MRC or CNN. If there really was an AIDS emergency the
people of the world would demand governments to do something about it
immediately or they would throw the rascals out. Instead, we read in
journals, official reports and newspapers that Africans, Asians, Indians,
etc. are in denial and must wake up to the AIDS emergency that they are
in.

AIDS is truly a disaster of colossal proportions but not for the
reasons given in headlines. The contagious/HIV hypothesis is the biggest
scientific, medical blunder of all time--and is easy to prove (2, 3).

"Can Africa be saved?" the cover of Newsweek asked as far back as
1984 (4), reflecting the old Western belief that Africa is doomed to
starvation, terror, disaster and death. This was repeated two years later
in an article in the same journal in a story about Aids in Africa. The
title set the scene: "Africa in the Plague Years" (5). It continued:
"Nowhere is the disease more rampant than in the Rakai region of south-
west Uganda, where 30 percent of the people are estimated to be
seropositive." The World Health Organisation (WHO) confirmed "by mid-1991
an estimated 1.5 million Ugandans, or about 9% of the general population
and 20% of the sexually active population, had HIV infection" (6). Similar
reports were repeatedly published during the last 15 years, declaring as
much as 30% of the population doomed to premature death, with dire
consequences for families and society as a whole? The predictions
announced the practically inevitable collapse of the country in which the
world-wide epidemic supposedly originated.

Today, however, one reads little about Aids in Uganda because all the
prophesies have proved false, as evidenced in the ten-year census of
September 2002 (7). Summing up, the Uganda Bureau of Statistics says,
"Uganda's Population grew at an average annual rate of 3.4% between 1991
and 2002. The high rate of population growth is mainly due to the
persistently high fertility levels (about seven children per woman) that
have been observed for the past four decades. The decline in mortality
reflected by a decline in Infant and Childhood Mortality Rates as revealed
by the Uganda Demographic and Health Surveys (UDHS) of 1995 and 2000-2001,
have also contributed to the high population growth rate." In other words,
the already very high population growth in Uganda has further increased
over the past 10 years and is now among the highest in the world (8).

Even if Uganda has so far escaped the apocalypse that was predicted
in 1984, the popular media continue to inform us that the whole of Sub-
Saharan Africa has suffered massive devastation and depopulation as a
result of two decades of AIDS. Notwithstanding the claims of the media, it
is extremely difficult to document an Africa AIDS catastrophe that some
have compared to the European plague of the Middle Ages.

A new AIDS epidemic was claimed to have emerged in Sub-Saharan Africa
in 1984 (9-14). In sharp contrast to its America and European namesakes,
the African AIDS epidemic is randomly distributed between the sexes and
not restricted to behavioral risk groups (15-17). The African epidemic is
also a collection of long-established, indigenous diseases, such as
chronic fevers, weight loss (alias "slim disease"), diarrhea and
tuberculosis (18-23). In addition, the African AIDS-defining diseases
differ from the American/European AIDS diseases significantly in their
prevalence among AIDS patients. For example, the predominant
American/European AIDS disease, Pneumocystis carinii pneumonia, is almost
never diagnosed in Africans (24, 25).

According to the WHO, the African epidemic increased from 1984 until
the early 1990s, similar to the American/European epidemics, but has since
leveled off to generate about 75,000 cases annually ((26) and back
issues). (By way of comparison, the plague epidemic of London in 1665 had
eliminated 1/3 of the population with plague-specific symptoms in a few
weeks to months [29] and the flu epidemic of 1918 eliminated 20 million in
one season (27).

By 2001, Africa had reportedly generated a cumulative total of
1,093,522 AIDS cases (26). But, during this period the population of Sub-
Saharan Africa had grown (at an annual rate of about 2.6% per year) from
378 million in 1980 to 652 million in 2000 (28). Therefore, a possible,
above-normal loss of 1 million lives to AIDS is statistically hard to
verify for two reasons: 1) the loss would be dwarfed by the overwhelming,
simultaneous gain of 274 million people (the equivalent of the population
of the USA), and 2) the African AIDS-defining diseases are
indistinguishable from conventional African morbidity and mortality (2).

Because of the many epidemiological and clinical differences between
African AIDS and its American/European namesake, and because of the many
uncertainties about the statistics on African AIDS (29), both the novelty
of African AIDS and its relationship to American/European AIDS have
recently been called into question (1, 29-36). Indeed, all available data
are compatible with a perennial African epidemic of poverty-associated
diseases under the new name AIDS (19, 22).

Because the WHO decided in 1985 to accept AIDS diagnoses without an
HIV-test, there is no reliable documentation for even an HIV epidemic in
Africa (29, 37). Such presumptive diagnoses were approved because the cost
of the HIV-antibody test is prohibitive for most Africans. As a result,
there are huge discrepancies in African AIDS statistics. For instance,
based on WHO information, the Durban Declaration claimed in 2000 that,
"24.5 million...are living with HIV or AIDS in Sub-Saharan Africa".
However, the WHO had reported no more than 81,565 new cases AIDS for the
whole African continent in that year (obtained by subtracting the
cumulative total of 794,444 in 1999 from the cumulative total of 876,009
in 2000) (38, 39).

African AIDS is assumed to be sexually transmitted.

The assumptions 1) that HIV is sexually transmitted and 2) there are
"24.5 million...living with HIV or AIDS in Sub-Saharan Africa" (40)
produce a sexual paradox. The fact that mainstream HIV researchers have
agreed that it takes on average 1000 unprotected sexual contacts with HIV-
positive partners to transmit HIV (36, 41, 42) means that an extraordinary
degree of sexual promiscuity is necessary in order to sustain a sexually
transmitted AIDS epidemic. Therefore, the level of sexual promiscuity in
Africa must be significantly greater than that in the USA and Europe where
the promised heterosexual AIDS epidemics never materialized (43). Thus, in
order to produce an African AIDS epidemic on the scale repeatedly reported
in the New York Times, by the WHO and UNAIDS requires massive, random
sexual promiscuity, far beyond that seen in the USA and Europe. The number
of random sexual contacts needed to spread a sexually transmitted HIV
epidemic in Sub-Saharan Africa is a straight forward calculation. Since
only 1 in 26 (24.5 million per 652 million) of Sub-Saharan Africans was
HIV-positive in 2000, each of the 24.5 million must have had an average of
1000 x 26 = 26,000 sexual contacts to reach the 1000 HIV-positive contacts
needed to acquire HIV and to spread an epidemic.

It strains credulity to accept that poor, hungry Sub-Saharan Africans
are engaging in such levels of sexual promiscuity. Indeed, the evidence is
strongly against it. A recent thorough epidemiological study of sexual
transmission of HIV in Africa found the same "low rates of heterosexual
transmission [of HIV], as in developed countries [and] no correlation
between the percent of adults...reporting non-regular sexual
partners...and HIV prevalence" (36). These and other anomalies led Brewer
et al. to "propose that existing data can no longer be reconciled with the
received wisdom about the exceptional role of sex in the African epidemic"
(44). Thus, either the assumption of the Durban Declaration that HIV is
sexually transmitted, or its claim that 24.5 million are HIV-positive, or
both are flawed. Nevertheless, we continue to read in newspapers and hear
on television that 25 million people have died of AIDS, and there are
upwards of 40 million people infected with HIV-and most of these are said
to be in Africa.

South Africa is the richest country in sub-Saharan Africa and has the
most reliable statistics on the continent. Statistics South Africa (Stats
SA) reports a constant growth in the population of South Africa from 38
million in 1994 to 43 million in 2001 (45, 46). Furthermore, the rise in
the number of deaths from all causes during the same period was also
constant, growing as the population grows-but no faster.

The latest antenatal screening survey in South Africa (47) also
failed to support the hypothesis that HIV is sexually transmitted but
instead confirms the conclusion of Brewer et al. that, "HIV is not
transmitted by 'sex'" (44). The survey included testing pregnant women for
syphilis and antibodies to HIV in order to see how the two diseases were
correlated by geographical location and over time. But, there was no
correlation. On the contrary, KwaZulu-Natal, which is leading when it
comes to HIV, has the lowest rate of syphilis in all provinces. Western
Cape, on the other hand, had the highest rate of syphilis in 2000 but the
lowest HIV prevalence. Northern Cape had the highest rate of syphilis in
2001 but the third lowest prevalence of HIV antibodies in that year.
Paradoxically, then, there is an inverse geographical correlation between
syphilis and HIV although both are said to be transmitted by heterosexual
intercourse. An even more extraordinary result is the divergence over time
between an increasing prevalence of antibodies to HIV and a declining rate
of syphilis. This is also difficult to understand given the assumption
that both are sexually transmitted.

A recent study in Uganda produced similar results. The intention of
the study had been to reduce HIV incidence by mass treatment of STDs with
conventional antibiotics. The rationale behind the study was that reducing
STDs (which was assumed to be a co-factor in the transmission of HIV)
should reduce the transmission of HIV. However, the result of the study
was paradoxical. While the investigators were very successful in
significantly reducing STDs, their intervention had "no [effect] on
incidence of HIV-1 infection..." (48).

The data from Thailand show that these paradoxical results are not
peculiar to Africa. Even though Thailand is said to be severely hit by a
heterosexually transmitted HIV-epidemic, we find yet again the same
scenario presented by South Africa and Uganda. Bangkok has the highest
rate of STDs but low HIV prevalence. Conversely, the so called Golden
Triangle of northern Thailand has the highest rate of HIV but the second
lowest STD morbidity of all regions. And, even within the different
provinces of the Northern Region there is a negative correlation between
HIV and syphilis (49). The conclusion from these observations is obvious:
HIV cannot be heterosexually transmitted.

African AIDS numbers are based on HIV-antibodies in pregnant women.

Before 1998, two HIV-antibody tests had been performed for the South
African surveys: one screening test and a confirmation test on the
positive samples. The second test was skipped from 1998 onwards, except in
Western Cape, even though generally it is the accepted standard to do at
least two tests. Furthermore, the manufacturer of the HIV-antibody test
that was used in the surveys specifically warns that, "non-specific
reactions may be seen in samples from some people who, for example, due to
prior pregnancy...have antibodies to the human cells or media in which HIV
-1 is grown for manufacture of the EIA" (50). In other words the test,
which may show false positive reactions in women with "prior pregnancy",
is being used in pregnant women without further confirmation or
adjustment. The insert that comes with the antibody test also warns that,
"at present there is no recognized standard for establishing the presence
or absence of HIV-1 antibody in human blood." This probably explains why
"Studies from seven African countries over the last 15 years show rates of
HIV incidence during antenatal and/or post-partum periods exceeding what
could be expected solely from sexual transmission" (51). Yet, these
problematic, unconfirmed results from pregnant women are then used to
estimate the frequency of HIV in the general population (52) and
eventually the whole of Sub-Saharan Africa.

Thus, there is no evidence that HIV is spreading through sexual
intercourse (or any other way) in Africa or anywhere else. Combined with
the evidence that Africa is not currently being devastated and depopulated
by an AIDS epidemic, the inability to document a sexually transmitted
epidemic of HIV shows that a future HIV-caused AIDS apocalypse in Africa
is unlikely.

David Rasnick,
Member of the Presidential AIDS Advisory Panel of South Africa

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Competing interests:
None declared

Competing interests: No competing interests

08 November 2003
David Rasnick
Visiting Scholar UC Berkeley
Berkeley, CA 94720