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| Farber | Africa, as the news media never tires of telling us, has become ground zero of the AIDS epidemic. The clinical definition of AIDS in Africa, however, is stunningly broad and generic, and was seemingly designed to be little other than a signal for funding. It is in no way comparable to Western definitions. The “Bangui definition” of AIDS was established in the city of Bangui in the Central African Republic, at a conference in 1985. The definition requires neither a positive HIV test nor a low T-cell count, as in the West, but only the presence of chronic diarrhea, fever, significant weight loss, and asthenia, as well as other minor symptoms. These happen to be the symptoms of chronic malnutrition, malaria, parasitic infections, and other common African illnesses. (In 1994 the definition was updated to suggest the use of HIV tests, but in practice they are prohibitively expensive.) Even when HIV tests are performed, many diseases that are endemic to Africa, such as malaria and TB, are known to cause false positives. The statistical picture of AIDS in Africa, consequently, is a communal projection based on very rough estimates of HIV positives, culled from select and small samples, which are extrapolated across the continent using computer models and highly questionable assumptions. |
| Gallo | Footnote 4 states that AIDS is defined differently in Africa. It is true that as more was learnt about AIDS, the definition of the disease changed. There is nothing unusual in this; AIDS was only discovered in 1981. It is a testimony to scientific methodology that it only took a few years to discover its cause. An accurate diagnosis of AIDS, throughout the world, does require an HIV-positive test. While there are facilities in Africa which do not even have HIV tests (one of the cheapest components of the medical response to HIV), our knowledge of HIV in Africa is based on studies that have used HIV tests. (Incidentally, facilities that cannot offer HIV testing do not offer ARVs either.) We show later that numerous studies conducted in Africa have demonstrated that people with HIV have much higher morbidity and mortality than people without HIV. Also see Nicoll and Killewo (2000). 24 |
| RA | The Gallo document is wrong to claim that HIV tests are needed for an AIDS definition. The World Health Organization’s 1986 ‘Bangui’ definition [1], updated in 1994 [2], states that HIV tests are not needed and that the definition can be based solely on common clinical symptoms: “For the purposes of AIDS surveillance an adult or adolescent (>12 years of age) is considered to have AIDS if at least 2 of the following major signs are present in combination with at least 1 of the minor signs listed below, and if these signs are not known to be due to a condition unrelated to HIV infection.Major signs…Advantages of the WHO case definition for AIDS surveillance are that it is simple to use and inexpensive since it does not rely on HIV serological [antibody] testing. Limitations of this case definition are its relatively low sensitivity [i.e. it misses people with AIDS] and its low specificity [i.e. it is prone to false positive diagnoses] particularly with respect to tuberculosis…” (our emphasis) |
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