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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 [WHO’s Bangui AIDS] 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 also states that AIDS happens to have the same symptoms as “chronic malnutrition, malaria, parasitic infections and other common African illnesses.” HIV, not poverty, predicts progression to AIDS in Africa. Of course, living in poverty increases the risk of acquiring HIV infection, because poor people have less access to information about how HIV is spread and how to avoid contracting this infection. Also, poor people, especially poor women, frequently have less power to negotiate the use of condoms. HIV-infected people living in resource-poor environments can progress more rapidly to AIDS and death because of their reduced access to health care and their diminished state of general health compared to individuals who reside in more affluent settings. As NIAID (2003) explains, the “diseases that have come to be associated with AIDS in Africa -such as wasting syndrome, diarrheal diseases and TB -have long been severe burdens there. However, high rates of mortality from these diseases, formerly confined to the elderly and malnourished, are now common among HIV-infected young and middle-aged people, including well-educated members of the middle class.”25 Sewankambo et al. (2000) is a study of nearly 20,000 people, both HIV-positive and HIV-negative in a Ugandan district. People with HIV were much more likely to get sick or die. Furthermore death rates in civil servants and the better-educated (i.e. not the poor) were higher than the general population. This was associated with HIV infection. 26 Statistics South Africa (2005) counted South African death certificates between 1997 and 2002 and found a 57% increase in mortality (only a small portion can be accounted for by improved death registration and population growth). Critically, most of this increase is accounted for in young adults, with the highest proportion of adult deaths in 2002 being 30-39 year olds. Child mortality has also risen dramatically. This is incompatible with poverty as the cause of AIDS, especially in a country where living standards improved to some degree (or at worst stayed the same) during the period studied. 27 Furthemore, some AIDS-related diseases, e.g. cryptococcal meningitis, are very rare in people without HIV, but very common in Africa in people with HIV. We provide further detail in the endnotes. 28 |
| RA | The World Health Organization “Bangui” definition of AIDS [1] (see rethinkaids.info/GalloRebuttal/Farber-Gallo-10.html) does not require a positive HIV test and is based on very generic symptoms such as fever, cough, diarrhea and weight loss. Even so, the Sewankambo paper that the Gallo document cites as evidence that “HIV, not poverty, predicts progression to AIDS in Africa” and which does show a very high death rate associated with positive HIV tests also states that “only 56 out of 615 deaths (9.1%) met the WHO criteria [for AIDS].” [2] This means that positive HIV tests are correlated with sickness, but not necessarily with AIDS. This is easy to explain if there is a high rate of false positive HIV tests or if HIV is just a “passenger virus” transmitted by risky activities (such as injections with unsterile needles). The danger of interpreting HIV tests as reliable indicators of AIDS is that it persuades people to accept a fatal diagnosis, which is enough to kill some people, and it also persuades people to accept toxic AIDS drugs, where they are available, which will also kill some people. |
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