Reappraising AIDS Vol. 3, no. 1

Reappraising

VOLUME 3, NUMBER 1

AIDS

JANUARY 1995

AIDS IN AFRICA?
Eleni Papadopulos-Eleopulos and Valendar F. Turner

According to the World Health Organisation, some
2.5 million Sub-Saharan Africans have AIDS-Africa is
apparently in the grip of an AIDS pandemic. (In the
USA 300,000 people have been listed as AIDS cases.)
AIDS in Africa is portrayed as providing two important
lessons for the West. The first is an example of the
potential devastation that AIDS can unleash; the second
is that by heterosexual spread, AIDS will eventually overtake the West. However, there is no convincing
evidence that millions of Africans are infected with HIV,
the putative cause of AIDS, or that African AIDS is
heterosexually spread.
The only evidence that some Africans are "infected" with
a virus called HIV is indirect, being based on the random
testing of Africans' blood for the presence of antibodies
that react with a collection of so-called HIV proteins.
If the "HIV proteins" (present in the test kits) only reacted
with HIV antibodies there would be no problem.
Unfortunately, this is not the case. Antibodies produced
in response to the presence of one foreign agent may
also react with another, different foreign agent; and the
more infectious agents that a person has been exposed
to, the greater is the likelihood that such cross-reacting
antibodies will be present. Ruling out cross-reactions
between "HIV proteins" and the plethora of other
antibodies present in individuals who are constantly
exposed to microbial agents, can only be achieved by
determining how good a match there is between the
antibody reactions and the presence or absence of
pure HIV itself. In other words, an isolated viral
preparation of known purity must be used as a "gold
standard" for the antibody reactions. This has never
been done, either in Africa or in the West. Thus in Africa,
no one knows whether the antibody tests are specific for
HIV, that is, whether a positive test actually means HIV
infection. Many experts on African AIDS accepted this
fact even at the beginning of the AIDS era. Earlier last
year Myron Essex, a leading American researcher, and his
colleagues from Harvard University, when discussing their
experimental data on HIV antibody testing in Africa,
again warned that the HIV antibody tests "may not be
sufficient for HIV diagnosis in AIDS-endemic areas of
Central Africa where the prevalence of mycobacterial
diseases [leprosy and tuberculosis and others, whose
antibodies cross-react] is quite high". Thus, in Africa there

is no certainty that Africans are actually infected with a
putative new agent, HIV. AIDS experts also agree that
acquired immune deficiency (the "AID" in AIDS) is also
long standing in Africa. Immune deficiency can be
caused by malnutrition, certain viral infections, and
diseases such as malaria and tuberculosis, all of which
are known to exert a major depressant action on the
immune system.
Unlike the West, AIDS in Africa is diagnosed without any
laboratory tests. Patients are classified as AIDS cases
without laboratory proof that they have either
immunodeficiency or HIV infection. All that is required
is to have various clinical conditions. But the
conditions accepted as forming the "S" (syndrome) of
"AIDS" in Africa bear no relationship to AIDS in the West.
In the West, AIDS is diagnosed if a person has one or
more of approximately 27 relatively rare diseases.
However in Africa, AIDS is diagnosed according to the
World Health Organisation's 1986/87 "Bangui" definitions
that can best be described as a collage of common
non-specific symptoms, such as cough, fever, diarrhea,
tuberculosis (TB) and a cancer called Kaposi's sarcoma.
Every one of these diseases has been endemic in Africa
for generations.
Kaposi's sarcoma, for example, was described in the
Ebers papyrus dating from 1600 BC. (in the West,
Kaposi's sarcoma is restricted to gay men.) Of the 661
million people in sub-Saharan Africa, 2-3 million have
active TB with an annual mortality of 790,000. Despite
this and the fact that in adults, "HIV infection" usually
follows TB infection, TB has now become an AIDS defining
illness. In fact, 30-50% of African "AIDS" deaths are from
TB. In spite of all this, AIDS experts expect that we should
accept that something "new" is afoot in Africa and
that it is caused by a new agent, HIV. Suddenly, a new
disease, caused by a new agent has appeared. The old
diseases and their deleterious effects on the immune
system are no longer operative.
Many AIDS experts also expect us to believe that
unlike the story in the West, in Africa AIDS is spread
predominantly by heterosexual contact. Indeed, since
the number of heterosexual cases in the West is too small