AIDS: Science at a Crossroads

available. Alcohol abuse is a growing problem among men, but not among women, who are at least
as severely affected by HIV as shown above. Few would doubt, however, that malnutrition may
accelerate the course of AIDS, as it appears to do in other diseases such as TB.
* AIDS is just a name for old diseases in Africa, such as malaria, TB or malnutrition. HIV is
innocent, the dissenters argue. But a study by Ugandan and British-funded researchers, published
in The Lancet in 1993 (and reported in 1992 at the IXth International Conference on AIDS in
Berlin, Germany) showed that people in rural southwest Uganda who were infected with HIV were
60 times more likely to die in young adulthood than people in the same community who were HIV
negative, even after potentially confounding factors had been considered.
* AIDS is not linked to HIV, and is not sexually transmitted. The epidemiology of HIV clearly runs
against this claim. Within populations, where HIV is found, AIDS is found too. And if the disease
were not the result of a sexually transmitted agent, it would not show the pattern of distribution
within societies that it does show: it is concentrated largely among sexually active younger adults
and, where the virus is prevalent, it is commonest among those who have unprotected sex with large
numbers of partners. Claims that the virus is "harmless" are cruel and dangerous, and insulting to
those who have been infected.
* AIDS is linked to AZT and its side effects. Most people with AIDS have never been within a mile
of AZT. The drug is economically beyond the reach of most people in developing countries. Within
the industrialised countries, where AZT has been available to most people with AIDS, controlled
trials have shown that the drug has significant side effects, but there has never been any evidence
from these trials that it "causes" any of the symptoms of AIDS.
Are HIV tests reliable?
Some dissenters also argue that the existing tests for detecting antibodies to HIV are unreliable. Tests
that are relatively affordable and used worldwide are designed to detect the antibodies that the immune
system makes to respond to HIV, and not to detect the virus itself. Tests to detect the virus require
expensive technology and sophisticated laboratories, and are generally not available in most
developing countries.
In the early years of AIDS, some highly-publicised studies found unconvincingly high rates of HIV
infection in certain communities in Africa, using the simple antibody test for the virus, known as an
enzyme-linked immunosorbent assay (ELISA). The figures quoted were sometimes as high as 60%. It
turned out that some of these tests were invalid because of reactions between some of the reagents in
the test and antibodies to malaria parasites in people's blood. Later-generations of tests have had no
such problem.
A more sophisticated test, the so-called Western Blot, has also now come under criticism, most
recently in 1993 in the journal Bio/Technology by researchers at the University of Western
Australia. Western Blot tests consist of bands on a gel that show the presence of antibodies to
viral proteins. In trained hands, these tests produce results as accurate as for any other infectious
disease. Poorly interpreted, they too could be misleading, however. For example, a Western Blot
from an uninfected person may show a single band corresponding to an HIV protein, but in the
absence of all the rest, it does not constitute a positive result. Careless or poorly-trained
laboratory workers may be reporting occasional false positive results.
But since most people in Africa have no access to laboratory tests for HIV, and many people become
ill and die without having been diagnosed, because of the lack of healthcare facilities and medical
personnel, the official figures are likely to be underestimates, not overestimates as the dissidents argue.

More importantly, WHO's figures are based on extrapolations from figures for known centres of
excellence, Tests carried out in the centres of excellence in sub-Saharan Africa, such as the Uganda
Virus Research Institute in Entebbe, are checked from time to time by participating laboratories in the
West and their results are as accurate as any industrialised country's (9).

9 - Panos Briefing: AIDS: SCIENCE AT A CROSSROADS