The Relationship between the Human Immunodeficiency Virus and the Acquired Immunodeficiency Syndrome (Draft)

DRAFT
1990, approximately 23 percent of a total of more than 9,600 women were HIV-positive
(Chiphangwi et al., 1990; Dallabetta et al., 1990). Approximately 20 percent of 547 blood
donors in a 1990 survey were HIV-positive (Kool et al., 1990).
In contrast, Madagascar, an island country off the southeast coast of Africa with a
population of 11.3 million, reported only 9 cases of AIDS to the WHO through June 1994
(WHO, 1994c; Latif, 1994). HIV seroprevalence is extremely low in this country; in recent
surveys of 1,629 blood donors and 1,111 pregnant women, no evidence of HIV infection was
found (Rasamindrakotroka et al., 1991). Yet, other sexually transmitted diseases are common
in Madagascar; a 1989 seroepidemiologic study for syphilis found that 19.5 percent of 12,457
persons tested were infected (Latif, 1994; Harms et al., 1994). It is likely that due to the
relative geographic isolation of this island nation HIV was introduced late into its population.
However, the high rate of other STDs such as syphilis would predict that HIV will spread in
this country in the future.
It has been argued that AIDS does not occur in Africa, and that the syndrome is
nothing more than a new name for old diseases (Duesberg, 1997-1992). It is true that the
diseases that have come to be associated with AIDS in Africa -- malnutrition, diarrheal
diseases and TB, and 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 (Essex, 1994). In a recent study in rural Uganda,
adolescents and young adults testing positive for HIV antibodies were 60 times as likely to die
during the subsequent 2-year observation period as were otherwise similar persons who
tested negative (Mulder et al., 1994). In a study of 390 children born to HIV-positive Ugandan
mothers and followed for 24 months, 84 were confirmed to be HIV-infected, 260 sero-reverted
and 46 had indeterminate HIV status. Mortality was 52 percent in the infected children, 65
percent in the indeterminate group, and only 5 percent among the seroreverters. Among a
control group of 146 children born to HIV-seronegative mothers, only 4% died by age two

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