As if AIDS isn’t bad enough

Without doubt, the HIV infection has embedded itself in the African population, and the subsequent onset of AIDS is a tragedy and personal disaster for a large number of Africans and their families. However, I question whether the campaigns of organisations such as UNAIDS are having a more negative than positive effect – and I certainly doubt the veracity of the statistics being provided by UNAIDS and the World Health Organisation (WHO).

In the mid-1980s the Global Program on AIDS (GPA – replaced by UNAIDS some years later) and the WHO estimated that somewhere between 750,000 and 6.5million Africans would be dying annually from AIDS by 1992. They exaggerated the true number by, at least, several hundred percent (1). In the early 1990s UNAIDS predicted some 50million HIV infections by 1999 and were out by a factor of two (2). More recently, a population survey carried out by the Kenyan government has shown that UNAIDS misestimated the prevalence of HIV in Kenya by a factor of two (3). This follows an earlier national survey in Mali, completed in 2001, that demonstrated prevalence of HIV to be half that previously estimated.

Scientific advisors to UNAIDS have been quick to point out that it is particularly difficult to gather reliable information from Africa. This is true, but it has not previously provided for any hesitation in pushing overblown AIDS statistics. UNAIDS head Peter Piot, for example, recently took part in a BBC World Service discussion of AIDS in Africa (4). The presenter opened the program by stating that ‘every five seconds someone somewhere is infected with HIV’. The statement was pure hyperbole, implying that the number of infected will double in between three and four years and will soon overrun Africa (*). Piot made no attempt to balance the comments, and during the discussion stated that the figures from Africa are ‘quite accurate estimates’.

It is not merely a pedantic question – although there is much to be said for scientists providing an honest portrayal of their figures. Instead, the eagerness to declare HIV worse than it apparently is reflects an expectation of disaster that perverts the understanding of the disease. This is not just an issue with AIDS – a tendency to assume the worst is now entrenched in medical science (5). However, the expectation has a particularly prurient and dangerous edge when it comes to Africa: AIDS is being used to interfere in the affairs of the African population.

A recent press release by the UNAIDS initiative, The Global Coalition on Women and AIDS, for example, described their efforts to inform African women that sexual fidelity is no protection against HIV (6). This is based on reports of twice the numbers of women than men carrying the HIV virus, a statistic that is apparently explained by promiscuous African men who are violent towards their wives and their daughters. As Lufine Anyango, national HIV/AIDS coordinator of ActionAid Kenya, explained during an interview I did for the BBC World Service, African men routinely rape their wives.

While I have little doubt that violence against women takes place in Africa, there is no reason to believe it is more of a problem than in other parts of the world. Sexual activity reported in a dozen general population surveys in Africa indicate comparable behaviour to that in Western Europe and North America (7). This data is routinely overlooked because the expectation of devastation in Africa derives its authority from a prejudiced view of Africa as the ‘Dark Continent’, where civilisation expresses itself only meekly, if at all.

This is not a new phenomenon. In 1908, an officer of the Royal Army Medical Corps, Colonel Lambkin published a report, ‘An outbreak of syphilis on virgin soil’, which generated concerned editorials from the British Medical Journal and the Lancet. Lambkin suggested that 80 per cent of the Ugandan population were infected and that infant mortality was approaching 50 to 60 per cent, threatening the very existence of ‘the race’. The Bishop of Uganda, Albert Tucker, emphasised the need to appreciate ‘female chastity’ to save the Baganda from extinction. The Reverend Roscoe also saw female promiscuity as the cause of syphilis, while medical missionary Albert Cook asserted that the disease was already ‘rampant’ in parts of Uganda (8).

The discussion of syphilis at the outset of the twentieth century reflected the tensions and dilemmas regarding colonial rule, and particularly the concern that Africa was slipping beyond control. Similarly, the focus on violent male promiscuity reflects prejudice today. Twice the number of women becoming infected with HIV by half as many men does not make sense if women are largely monogamous, goes the reasoning. The virus is not so easy to transmit that the occasional casual encounter will drive the statistics in such a direction, unless you posit the existence of some super-infective or super-promiscuous males, or a combination of the two. Just as the existence of ‘female animals with strong passions’ (9) were suggested to account for the apparent devastation of syphilis, the prejudiced expectation of violent and sexually promiscuous African men finds a modern justification in what appear as the indisputable facts of HIV and AIDS.

Assuming UNAIDS have their figures correct, however, it is plausible that an alternate source of infection exists. One possibility is that females are exposed to medical care more than their male counterparts, largely through pregnancy, and are at greater risk of receiving the virus iatrogenically – via reused, infected, needles (10). This would also explain why prior UNAIDS figures have been overestimated, since they routinely extrapolate from surveys of pregnant women.

In fact, the possibility of iatrogenic transmission was put forward last year by consultant David Gisselquist (see AIDS in Africa: sense at last). You might expect UNAIDS to have investigated the possibility before putting out a press release that will clearly cause anxiety among African women believing themselves to be in a faithful relationship. A blunt message of deadly infidelity may well cause separation, one-parent families, homelessness, violence against women and other hostilities, all of which will serve as a self-fulfilling prophecy regarding the out-of-control nature of Africa. UNAIDS is aware of the social dislocation that can be caused by a disease, but are surprisingly insensitive to the dislocation created by its own campaigns.

Helping Africa is not complicated. The continent is poor but not devastated. Elimination of African debt and the availability of cheap retroviral drugs and medication for malaria, TB and other established disease would have massive, profound and almost immediate benefits. Instead UNAIDS offers at best a patronising and insulting message to women and young girls that they need to be wary of their husbands and fathers. At worst, this is another ‘civilising’ project that will exacerbate tensions and further strengthen the hand of external agencies in their dominance over African affairs.

Stuart Derbyshire is an assistant professor in the University of Pittsburgh Department of Anaethesiology. He is a contributor to Animal Experimentation: Good or Bad?, Hodder Murray, 2002 (buy this book from Amazon (UK) or Amazon (USA)).

Read on:

AIDS in Africa: why the West is interested, by Stuart Derbyshire

AIDS in Britain: why complacency is justified

(*) Correction: when first published this article incorrectly stated that the figure would amount ‘to the entire population of the world being infected in 10 years, or that of Africa in less than five’.

(1) 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: 633.

(2) Aids in Africa: Why the West is interested, by Dr Stuart Derbyshire

(3) Study cuts Kenya HIV estimates, BBC News World Edition, 9 January 2004

(4) Ask the head of UNAIDS, BBC News, 17 November 2003

(5) Therapy Culture: Cultivating Vulnerability in an Uncertain Age, by Frank Furedi, Routledge, 2003 (Buy this book from Amazon(UK); Cellular Phones, Public Fears and a Culture of Precaution, by Adam Burgess, Cambridge University Press, 2003 (Buy this book from Amazon(UK); The Tyranny of Health: Doctors and the Regulation of Lifestyle, by Michael Fitzpatrick, Routledge, 2000 (Buy this book from Amazon(UK); Second Opinion: Doctors, Diseases and Decisions in Modern Medicine [review], by Stuart Derbyshire, British Medical Journal 2003; 327: 399

(6) Global Coalition on Women and AIDS

(7) Carael M, Cleland J, Deheneffe J-C, Ferry B, Ingham R., Sexual behavior in developing countries: implications for HIV control, AIDS 1995;9:1171-1175

(8) Syphilis in colonial East and Central Africa: the social construction of an epidemic, by M. Vaughan, in Epidemics and Ideas: Essays on the Historical Perception of Pestilence, edited by Terence O. Ranger, Paul Slack. Cambridge Press, 1995

(9) Editorial, Lancet 1908; 2: 1022.
(10) David Gisselquist, John J Potterat, StuartBrody, Francois Vachon, Let it be sexual: how health care transmission of AIDS in Africa was ignored, International Journal of STD and AIDS 2003, 14, p148 -161