Damned Heretics

Condemned by the established, but very often right

I am Nicolaus Copernicus, and I approve of this blog

I am Richard Feynman and I approve of this blog

Qualified outsiders and maverick insiders are often right about the need to replace received wisdom in science and society, as the history of the Nobel prize shows. This blog exists to back the best of them in their uphill assault on the massively entrenched edifice of resistance to and prejudice against reviewing, let alone revising, ruling ideas. In support of such qualified dissenters and courageous heretics we search for scientific paradigms and other established beliefs which may be maintained only by the power and politics of the status quo, comparing them with academic research and the published experimental and investigative record.

We especially defend and support the funding of honest, accomplished, independent minded and often heroic scientists, inventors and other original thinkers and their right to free speech and publication against the censorship, mudslinging, false arguments, ad hominem propaganda, overwhelming crowd prejudice and internal science politics of the paradigm wars of cancer, AIDS, evolution, global warming, cosmology, particle physics, macroeconomics, health and medicine, diet and nutrition.

HONOR ROLL OF SCIENTIFIC TRUTHSEEKERS

Henry Bauer, Peter Breggin , Harvey Bialy, Giordano Bruno, Erwin Chargaff, Nicolaus Copernicus, Francis Crick, Paul Crutzen, Marie Curie, Rebecca Culshaw, Freeman Dyson, Peter Duesberg, Albert Einstein, Richard Feynman, John Fewster, Galileo Galilei, Alec Gordon, James Hansen, Edward Jenner, Benjamin Jesty, Michio Kaku, Adrian Kent, Ernst Krebs, Thomas Kuhn, Serge Lang, John Lauritsen, Mark Leggett, Richard Lindzen, Lynn Margulis, Barbara McClintock, George Miklos, Marco Mamone Capria, Peter Medawar, Kary Mullis, Linus Pauling, Eric Penrose, Max Planck, Rainer Plaga, David Rasnick, Sherwood Rowland, Carl Sagan, Otto Rossler, Fred Singer, Thomas Szasz, Alfred Wegener, Edward O. Wilson, James Watson.
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Many people would die rather than think – in fact, they do so. – Bertrand Russell.

Skepticism is dangerous. That’s exactly its function, in my view. It is the business of skepticism to be dangerous. And that’s why there is a great reluctance to teach it in schools. That’s why you don’t find a general fluency in skepticism in the media. On the other hand, how will we negotiate a very perilous future if we don’t have the elementary intellectual tools to ask searching questions of those nominally in charge, especially in a democracy? – Carl Sagan (The Burden of Skepticism, keynote address to CSICOP Annual Conference, Pasadena, April 3/4, 1982).

It is really important to underscore that everything we’re talking about tonight could be utter nonsense. – Brian Greene (NYU panel on Hidden Dimensions June 5 2010, World Science Festival)

I am Albert Einstein, and I heartily approve of this blog, insofar as it seems to believe both in science and the importance of intellectual imagination, uncompromised by out of date emotions such as the impulse toward conventional religious beliefs, national aggression as a part of patriotism, and so on.   As I once remarked, the further the spiritual evolution of mankind advances, the more certain it seems to me that the path to genuine religiosity does not lie through the fear of life, and the fear of death, and blind faith, but through striving after rational knowledge.   Certainly the application of the impulse toward blind faith in science whereby authority is treated as some kind of church is to be deplored.  As I have also said, the only thing ever interfered with my learning was my education. My name as you already perceive without a doubt is George Bernard Shaw, and I certainly approve of this blog, in that its guiding spirit appears to be blasphemous in regard to the High Church doctrines of science, and it flouts the censorship of the powers that be, and as I have famously remarked, all great truths begin as blasphemy, and the first duty of the truthteller is to fight censorship, and while I notice that its seriousness of purpose is often alleviated by a satirical irony which sometimes borders on the facetious, this is all to the good, for as I have also famously remarked, if you wish to be a dissenter, make certain that you frame your ideas in jest, otherwise they will seek to kill you.  My own method was always to take the utmost trouble to find the right thing to say, and then to say it with the utmost levity. (Photo by Alfred Eisenstaedt for Life magazine) One should as a rule respect public opinion in so far as is necessary to avoid starvation and to keep out of prison, but anything that goes beyond this is voluntary submission to an unnecessary tyranny, and is likely to interfere with happiness in all kinds of ways. – Bertrand Russell, Conquest of Happiness (1930) ch. 9

(Click for more Unusual Quotations on Science and Belief)

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How Rian Malan sniffed out the rat in South African AIDS

Rian Molan’s Nov 2001 Rolling Stone article on the South African AIDS mirage exposed the fiction in the ‘facts’

Appropos of the global AIDS (non) pandemic issue, it seems worth asking this question. Which would you rather believe on AIDS, the New York Times or the Rolling Stone?

The AIDS reporters at the Times are headed by Lawrence Altman, who has consistently hewed to the party line with rare exceptions where he actually notes some of the smaller anomalies of mainstream AIDS thinking.

Perhaps this is because he was trained at the CDC, and is therefore unlikely to contradict that institution too often, despite its atrocious performance on AIDS and AIDS statistics, which mathematician Serge Lang of Yale has trashed so thoroughly in his book Challenges (Springer-Verlag New York 1998) and in Lang Files, mailed around the country to key journalists including Altman.

Rolling Stone on the other hand achieved the following remarkable report in 2001, which states that AIDS in South Africa (then said by UNAIDS to be running at 17 million Africans dead of AIDS and 25 million more with HIV, with one in four South African adults infected) was a no show. Couldn’t be found. Didn’t seem to exist. No AIDS epidemic.

What? Yes, Rian Molan, a South African novelist of some repute, was asked by Jan Wenner of Rolling Stone to do a nice report on AIDS in South Africa in all its gory glory, and apparently was promised enough ready money and expenses to set out with great confidence and enthusiasm to do same. But almost immediately he ran into a problem: where were all the AIDS patients? According to everybody’s belief and the news media reports domestic and international. there should have been so many of them the sick should have been littering the sidewalks of Capetown and the Soweto shantytowns and kraals of that fair country (the climate is roughly equivalent to European countries of the same latitude).

But nada. Ryan couldn’t find the epidemic. Yes, there were plenty of patients sick and dying but no more than there had ever been, as far as he could find. Even the coffin makers were complaining. Where was all the booming business they had been led to expect?

Molan emailed Wenner to this effect and was told not to worry, the AIDS epidemic was surely there, just keep going. So he did. To no avail. Finally, he had the bright idea of going to check the death statistics of South Africa. Well, what d’ya know? They hadn’t budged by any significant amount that didn’t reflect the burgeoning population growth that South Africa in common with the rest of the sub-Sahara has enjoyed for the past quarter century.

In other words, no bulge. So, no discernible AIDS epidemic. And no payment to Molan, it looked like. But Wenner said, Well, write the story anyway. and he did. And this is it below, if you care to read it. But don’t tell anyone you read it, at least not before finding out whether they are a fully paid up member of the AIDS orthodoxy. For in general, such corrective heresy does not go down too well with HIV supporters.

As indeed Rian Molan’s wife clearly appreciated. As Molan later told it, she stood behind him with a rolling pin as he typed threatening to whack him over the noggin if he continued to write such subversive thoughts.

Here are a few sample paragraphs to whet the appetite of those readers who find reading more than a hundred words at a time on the Web daunting. Let us say one thing, though: Rian’s article is the best quick survey of the problems with the “global AIDS pandemic” available anywhere. You’ll see exactly why, among other things, HIV testing in Africa is a farce.

A statistical non-epidemic

Geneva’s computer models suggested that AIDS deaths here had tripled in three years, surging from 80,000-odd in 1996 to 250,000 in 1999. But no such rise was discernable in total registered deaths, which went from 294,703 to 343,535 within roughly the same period. The discrepancy was so large that I wrote to make absolutely sure I had understood these numbers correctly. Both parties confirmed that I had, and at that exact moment, my story was in trouble. Geneva’s figures reflected catastrophe. Pretoria’s figures did not.

How scientists really behave

There was a time when I imagined medical research as an idealized

endeavor, carried out by scientists interested only in truth. Up close, it turns out to be much like any other human enterprise, riven with envy, ambition and the standard jockeying for position. Labs and universities depend on grants, and grant making is fickle, subject to the vagaries of politics and intellectual fashion, and prone to favor scientists whose work grips the popular imagination. Every disease has champions who gather the data and proclaim the threat it poses. The cancer fighters will tell you that their crisis is deepening, and more research money is urgently needed. Those doing battle with malaria make similar pronouncements, as do those working on TB, and so on, and so on. If all their claims are added together, you wind up with a theoretical global death toll that “exceeds the number of humans who die annually by two- to threefold,” said Christopher Murray, a World Health Organization director.

No one for the coffins

One newspaper account I found told of a company called Affordable Coffins, purveyor of cheap cardboard caskets, which had more orders than it could fill. But the firm was barely two months old when the story ran, and two rival entrepreneurs who launched similar products a few years back had gone under. “People weren’t interested,” said a dejected Mr. Rob Whyte. “They wanted coffins made of real wood.” So I called the real-wood firms, three industrialists who manufactured coffins on an assembly line for the national market. “It’s quiet,” said Kurt Lammerding of GNG Pine Products. His competitors concurred – business was dead, so to speak. “It’s a fact,” said Mr. A. B. Schwegman of B&A Coffins. “If you go on what you read in the papers, we should be overwhelmed, but there’s nothing. So what’s going on? You tell me.”

How the WHO cook up the stats

.. the WHO devised an alternative, by which Africa’s AIDS statistics are now primarily based. It works like this: On any given morning anywhere in sub-Saharan Africa, you’ll find crowds of expectant mothers ling up outside government prenatal clinics, waiting for a routine checkup that includes the drawing of a blood sample to test for syphilis.

According UNAIDS, “anonymous blood specimens left over from these tests are tested for antibodies to HIV,” a ritual that usually takes place once a year. The results are fed into a computer model that uses “simple back-calculation procedures” and knowledge of “the well-known natural course of HIV infection” to produce statistics for the continent In other words, AIDS researchers descend on selected clinics, remove the leftover blood samples and screen them for traces of HIV The results are forwarded to Geneva and fed into a computer program called Epi-model: If a given number of pregnant women are HIV-positive, the formula says, then a certain percentage of all adults and children are presumed to be infected, too. And if that many people are infected, it follows that a percentage of them must have died. Hence, when UNAIDS announces 14 million Africans have succumbed to AIDS, it does not mean 14 million infected bodies have been counted. It means that 14 million people have theoretically died, some of them unseen in Africa’s swamps, shantytowns and vast swaths of terra incognita.

It’s malaria, stupid

It seemed something was confounding the tests, and the prime suspect was plasmodium falciparum, one of the parasites that causes malaria: Of the twenty-one subjects who tested positive, sixteen had had recent malaria infections and huge levels of antibody in their veins. The researchers tried an experiment: They formulated a preparation that absorbed the malaria antibodies, treated the blood samples with it, then retested them. Eighty percent of the suspected HIV infections vanished. The researchers themselves admitted that these findings were inconclusive. Still, considering that Africa is home to an estimated ninety percent of the world’s malaria cases, the implications of the report seemed intriguing.

And TB

Back in 1994, Max Essex, head of the Harvard AIDS Institute, and some colleagues of his observed a “very high” (sixty-three percent) rate of ELISA false positives among lepers in central Africa. Mystified, they probed deeper and pinpointed the cause: two cross-reacting antigens, one of which, lipoarabinomannan, or LAM, also occurs in the organism that causes TB. This prompted Essex and his collaborators to warn that ELISA results should be “interpreted with caution” in areas where HIV and TB were co-endemic. Indeed, they speculated that existing antibody tests “may not be sufficient for HIV diagnosis” in settings where TB and related diseases are commonplace.

Bumping up the numbers to no avail

A year later, I decided to return to my point of departure to see if the discrepancy persisted. I wrote to the country’s Department of Home Affairs, which manages the death register, and asked for the latest numbers. In response came a set of figures somewhat different from those initially provided – the consequence, I am told of people who died without any identity documents. Here is the final analysis:

Deaths registered in 1996 – 363,238.

Deaths registered in 2000 – 457,335.

As you see, registered deaths have indeed risen – not to the extent prophesied by the United Nations, perhaps, but there is definite movement in an ominous direction. Deaths are up across the board, but concentrated in certain critical age groups: females in their twenties, and males age thirty to thirty-nine.A team of experts commissioned by the Medical Research Council has studied this changing death pattern and found it to be “largely consistent with the pattern predicted by [ours] and other models of

the AIDS epidemic.” Their conclusion: AIDS has become the “biggest cause” of mortality in South Africa, responsible for forty percent of adult deaths. And yet, and yet, and yet, even this is not the end of our tale, because another governmental body, Stats SA, has challenged these findings. The Washington Post reported that the South African census bureau called the MRC study “badly flawed,” saying “the samples were

not representative, and assumptions about the probability of the transmission of the virus that causes AIDS were not necessarily accurate.”

The shockingly inadequate method

The UNAIDS computer model of Africa’s epidemic is in fact completely dependable, Dr. Schwartlander says because it relies on a “very

simple formula. You take the pregnancy-clinic numbers. You take the

median survival time – around nine years in Africa. You say this is roughly the distribution curve. Calculation of deaths is completely plausible if – and this is important – you have a good idea of the prevalence of HIV and how it spreads over time.” Why then, I asked, do we have so many different estimates of AIDS deaths in South Africa? “I’m not shocked,” he said. “The models may completely disagree at a particular point in time, but in the end the curves look incredibly similar. They’re goddamn consistent.”

If that’s true, I said, then why would we have 457,000 registered deaths here last year when the UN says 400,000 of them died of AIDS? One of those numbers must be wrong.

Note that Molan, even though he implies Thabo Mbeki may be on the right track in his suspicions, never quite gets to the stage of accepting or even imagining that HIV might not cause anything at all, and the whole puzzle easily resolved by simply throwing out this problematical paradigm, and instead of what may be a vast process of reinterpreting all these other sources of human sickness and death such as malaria and TB, and calling them AIDS, simply recognize them for what they are: Not AIDS but TB, Not AIDS but malaria, etc.

In other words, you don’t have to be an “HIV denialist” to see that the whole African pandemic is a crock. But you do lack an answer as to what the heck is going on.

Here is the whole classic tale, which essentially went nowhere in terms of rocking the HIV=AIDS boat, possibly because Jan Wenner runs into Mathilde Krim too often on the dinner party circuit in Manhattan.:

(show)

eprinted from RollingStone Magazine, November 22, 2001

AIDS in Africa: In Search of the Truth

By Rian Malan

“The frightening numbers were all that mattered. Once they were shown

to be accurate, further debate would be rendered obscene. So I set

out to confirm the death toll. I thought it would be easy—my first

mistake…”

===

1. MY FIRST MISTAKE

Africa’s era of mega death dawned in the fall of 1983, when the chief

of internal medicine of a hospital in what was then Zaire sent a

communiqué to American health officials, informing them that a

mysterious disease seemed to have broken out among his patients. At

the time, the United States was being convulsed by its own weird

health crisis. Large numbers of gay men were coming down with an

unknown disease of extraordinary virulence, something never seen in

the West before. Scientists called it GRID, an acronym for

Gay-Related Immune Deficiency. Political conservatives and holy men

called it God’s vengeance on sinners. American researchers were thus

intrigued that a similar syndrome had been observed in heterosexuals

in Africa. A posse of seasoned disease cowboys was convened and sent

forth to investigate.

On October 18th, 1993, they walked into Kinshasa’s Mama Yemo

Hospital, led by Peter Piot, 34, a Belgian microbiologist who had

been to the institution years earlier, investigating the first

outbreak of Ebola fever. A change was immediately apparent. “In 1976,

there were hardly any young adults in orthopedic wards,” Piot told a

reporter. “Suddenly – boom – I walked in and saw all these young men

and women, emaciated, dying.” Tests confirmed his worst

apprehensions: The mysterious new disease was present in Africa, and

its victims were heterosexual. When researchers started looking for

the newly identified human immunodeficiency virus, it turned up

almost everywhere – in eighty percent of Nairobi prostitutes,

thirty-two percent of Ugandan truck drivers, forty-five percent of

hospitalized Rwandan children. Worse, it seemed to be spreading very

rapidly. Epidemiologists plotted figures on graphs, drew lines

linking the data points and gaped in horror. The epidemic curve

peaked in the stratosphere. Scores of millions – maybe more – would

die unless something was done.

These prophecies transformed the destiny of AIDS. In 1983, it was a

fairly rare disease, confined largely to the gay and heroin-using

subcultures of the West. A few years later, it was a threat to all of

humanity itself. “We stand nakedly before a pandemic as mortal as any

there has ever been,” World Health Organization chief Halfdan Mahler

told a press conference in 1986. Western governments heeded his

anguished appeal for action. Billions were invested in education and

prevention campaigns. According to the Washington Post, impoverished

AIDS researchers suddenly had budgets that outstripped their spending

capacity. Nongovernmental AIDS organizations sprang up all across

Africa – 570 of them in Zimbabwe, 300 in South Africa, 1,300 in

Uganda. By 2000, global spending on AIDS had risen to many billions

of dollars a year, and activists were urging the commitment of many

billions more, largely to counter the apocalypse in Africa, where 22

million were said to carry the virus and 14 million to have died of

it.

And this is about where I entered the picture – July 2000, three

months after South African President Thabo Mbeki announced that he

intended to convene a panel of scientists and professors to

re-examine the relationship between the human immunodeficiency virus

and AIDS. Mbeki never exactly said AIDS doesn’t exist, but his action

begged the question, and the implications were mind-bending. South

Africa was said to have more HIV infections (4.2 million) than any

other country on the planet. One in five adults were already

infected, and the toll was rising daily. As his words sank in,

disbelief turned to derision.

“Ludicrous,” said the Washington Post.

“Off his rocker,” said the Spectator.

“A little open-mindedness is fine,” said Newsday. “But a person can

be so open-minded, his brains can fall out.”

The whole world laughed, and I rubbed my hands with glee: South

Africa was back on the world’s front pages for the first time since

the fall of apartheid; fortune awaited the man of action. I went to

see a friend who happens also to be an AIDS epidemiologist. He was so

enraged by what he called the “genocidal stupidity” of Mbeki’s

initiative that he’d left work and gone home, where I found him

slumped in depression. “Hey,” I said, snap out of it. Let’s make a

deal.” And so we did: He’d talk, I’d type, and together we’d tell the

inside story of Thabo Mbeki’s AIDS fiasco. All that remained was to

consider to consider the evidence that had led our leader astray.

According to newspaper reports, Mbeki had gleaned much of what he

knew from the Web, so I revved up the laptop and followed him into

the virtual underworld of AIDS heresy, where renegade scientists

maintain Web sites dedicated to the notion that AIDS is a hoax,

dreamed up by a diabolical alliance of pharmaceutical companies and

“fascist” academics whose only interest is enriching themselves. I

visited several such sites, noted what they had to say, and then

turned to Web sites maintained by universities and governments, which

offered crushing rebuttals. Can’t say I understood everything,

because the science was deep and dense, but here’s the gist:

Look at AIDS from an African point of view. Imagine yourself in a mud

hut, or maybe a tin shack on the outskirts of some sprawling city.

There’s sewage in the streets, and refuse removal is nonexistent.

Flies and mosquitoes abound, and your drinking water is probably

contaminated with feces. You and your children are sickly,

undernourished and stalked by diseases for which you’re unlikely to

receive proper treatment. Worse yet, these diseases are mutating,

becoming more virulent and drug-resistant. Minor scourge such as

diarrhea and pneumonia respond sluggishly to antibiotics. Malaria now

shrugs off treatment with chloroquine, which is often the only drug

for it available to poor Africans. Some strains of tuberculosis –

Africa’s other great killer – have become virtually incurable. Now

atop all this is AIDS.

According to what you hear on the radio, AIDS is caused by a tiny

virus that lurks unseen in the blood for many years, only to emerge

in deep disguise: a disease whose symptoms are other diseases, like

TB, for instance. Or pneumonia. Running stomach, say, or bloody

diarrhea in babies. These diseases are not new, which is why some

Africans have always been skeptical, maintaining that AIDS actually

stands for “American Idea for Discouraging Sex.” Others say nonsense,

the scientists are right; we’re all going to die unless we use

condoms. But condoms cost money and you have none, so you just sigh

and hope for the best.

Then one day you get a cough that won’t go away, and you start

shedding weight at an alarming rate. You know these symptoms. In the

past, you could take some pills and they would usually go away. But

the medicines don’t work anymore. You get sicker and sicker. You wind

up in the AIDS ward.

The orthodox scientists, if they could see you lying there, would say

your immune system has been destroyed by HIV, allowing the

tuberculosis (or whatever) to run riot. The dissidents would say no

way – the virus is a harmless creature that just happens to accompany

immune-system breakdown caused by other factors, in this case a

lifetime of hunger and exposure to tropical pathogens.

Incensed by this, the orthodoxy whistles up a truckload of studies

from all over Africa showing that HIV-positive hospital patients die

at astronomical rates relative to their HIV-negative counterparts.

The dissidents claim to be unimpressed. This proves nothing, they say

except that dying hospital patients carry the virus.

The orthodoxy grits its teeth. There’s only one way to crush these

rebels, and that’s to show that AIDS is a new disease that has caused

a massive increase in African mortality, which is of course the truth

as we know it: 22 million Africans infected, with 14 million more

already dead from it.

These frightening numbers were all that mattered, it seemed to me.

Once they were shown to be accurate, further debate would be rendered

obscene, and Thabo Mbeki would be guilty as charged, a fool who’d

allowed himself to be swayed by a tiny band of heretics universally

dismissed as wackos, fringe lunatics and scientific psychopaths. So I

set out to confirm the death toll. Just that. I thought it would be

easy – a call or two, maybe a brief interview. I picked up the phone.

It was my first mistake.

2. A Forbidden Thought

There was a time when I imagined medical research as an idealized

endeavor, carried out by scientists interested only in truth. Up

close, it turns out to be much like any other human enterprise, riven

with envy, ambition and the standard jockeying for position. Labs and

universities depend on grants, and grant making is fickle, subject to

the vagaries of politics and intellectual fashion, and prone to favor

scientists whose work grips the popular imagination. Every disease

has champions who gather the data and proclaim the threat it poses.

The cancer fighters will tell you that their crisis is deepening, and

more research money is urgently needed. Those doing battle with

malaria make similar pronouncements, as do those working on TB, and

so on, and so on. If all their claims are added together, you wind up

with a theoretical global death toll that “exceeds the number of

humans who die annually by two- to threefold,” said Christopher

Murray, a World Health Organization director.

Malaria kills around 2 million humans a year, roughly the same number

as AIDS, but malaria research currently gets only a fraction of the

resources devoted to AIDS. Tuberculosis (1.7 million victims a year)

is similarly sidelined, to the extent that there were no new TB drugs

in development at all as of 1998. AIDS, on the other hand, is

replete, employing an estimated 100,000 scientists, sociologists,

caregivers, counselors, peer educators and stagers of condom

jamborees. Until the attacks of September 11th diverted the world’s

anxieties (and charity dollars), the level of funding for AIDS grew

daily as foundations, governments and philanthropists such as Bill

Gates entered the field, unnerved by the bad news, which usually

arrived in the form of articles describing AIDS as a “merciless

plague” of “biblical virulence,” causing “terrible depredation” (as

Time recently put it) among the world’s poorest people.

These stories all originate in Africa, but the statistics that

support them emanate from the suburbs of Geneva, where the World

Health Organization has its headquarters. Technically employed by the

United Nations, WHO officials are the world’s disease police,

dedicated to eradicating illness. They crusade against old scourges,

raise the alarm against new ones, fight epidemics, and dispense

grants and expertise to poor countries. In conjunction with UNAIDS

(the joint United Nations Program on HIV/AIDS, based at the same

Geneva campus), the WHO also collects and disseminates information

about the AIDS pandemic.

In the West, the collection of such data is a fairly simple matter:

Almost every new AIDS case is scientifically verified and reported to

government health authorities, who inform the disease police in

Geneva. But AIDS mostly occurs in Africa, where hospitals are thinly

spread, understaffed and often bereft of the laboratory equipment

necessary to confirm HIV infections. How do you track an epidemic

under these conditions? In 1985, the WHO asked experts to hammer out

a simple description of AIDS, something that would enable bush

doctors to recognize the symptoms and start counting cases, but the

outcome was a fiasco – partly because doctors struggled to diagnose

the disease with the naked eye, but mostly because African

governments were too disorganized to collect the numbers and send

them in. Once it become clear that the case-reporting system wasn’t

working, the WHO devised an alternative, by which Africa’s AIDS

statistics are now primarily based.

It works like this: On any given morning anywhere in sub-Saharan

Africa, you’ll find crowds of expectant mothers ling up outside

government prenatal clinics, waiting for a routine checkup that

includes the drawing of a blood sample to test for syphilis.

According UNAIDS, “anonymous blood specimens left over from these

tests are tested for antibodies to HIV,” a ritual that usually takes

place once a year. The results are fed into a computer model that

uses “simple back-calculation procedures” and knowledge of “the

well-known natural course of HIV infection” to produce statistics for

the continent In other words, AIDS researchers descend on selected

clinics, remove the leftover blood samples and screen them for traces

of HIV The results are forwarded to Geneva and fed into a computer

program called Epi-model: If a given number of pregnant women are

HIV-positive, the formula says, then a certain percentage of all

adults and children are presumed to be infected, too. And if that

many people are infected, it follows that a percentage of them must

have died. Hence, when UNAIDS announces 14 million Africans have

succumbed to AIDS, it does not mean 14 million infected bodies have

been counted. It means that 14 million people have theoretically

died, some of them unseen in Africa’s swamps, shantytowns and vast

swaths of terra incognita.

You can theorize at will about the rest of Africa and nobody will

ever be the wiser, but my homeland is different – we are a

semi-industrialized nation with a respectable statistical service.

“South Africa,” says Ian Timaeus, London School of Hygiene and

Tropical Medicine professor and UNAIDS consultant “is the only

country in sub-Saharan Africa where sufficient deaths are routinely

registered to attempt to produce national estimates of mortality from

this source.” He adds that, “coverage is far from complete,” but

there’s enough of it to be useful – around eight of ten deaths are

routinely registered in South Africa, according to Timaeus, compared

to about 1 in 100 elsewhere below the Sahara.

It therefore seemed to me that checking the number of registered

deaths in South Africa was the surest way of assessing the statistics

from Geneva, so I dug out the figures. Geneva’s computer models

suggested that AIDS deaths here had tripled in three years, surging

from 80,000-odd in 1996 to 250,000 in 1999. But no such rise was

discernable in total registered deaths, which went from 294,703 to

343,535 within roughly the same period. The discrepancy was so large

that I wrote to make absolutely sure I had understood these numbers

correctly. Both parties confirmed that I had, and at that exact

moment, my story was in trouble. Geneva’s figures reflected

catastrophe. Pretoria’s figures did not. Between these extremes lay a

gray area populated by local experts such as Stephen Kramer, manager

of insurance giant Metropolitan’s AIDS Research Unit, whose own

computer model shows AIDS deaths at about one-third Geneva’s

estimates. But so what? South African actuaries don’t get a say in

this debate. The figures you see in your newspapers come from Geneva.

The WHO takes pains to label these numbers estimates only, not

rock-solid certainties, but still, these are estimates we all accept

as the truth.

But you don’t want to hear this, do you? Nor did I. It spoiled the

plot, so I tried to ignore it. Since it was indeed true that the very

large numbers of South Africans were dying, then the nation’s coffin

makers had to be laboring hard to keep pace with growing demand. One

newspaper account I found told of a company called Affordable

Coffins, purveyor of cheap cardboard caskets, which had more orders

than it could fill. But the firm was barely two months old when the

story ran, and two rival entrepreneurs who launched similar products

a few years back had gone under. “People weren’t interested,” said a

dejected Mr. Rob Whyte. “They wanted coffins made of real wood.”

So I called the real-wood firms, three industrialists who

manufactured coffins on an assembly line for the national market.

“It’s quiet,” said Kurt Lammerding of GNG Pine Products. His

competitors concurred – business was dead, so to speak.

“It’s a fact,” said Mr. A. B. Schwegman of B&A Coffins. “If you go on

what you read in the papers, we should be overwhelmed, but there’s

nothing. So what’s going on? You tell me.”

I couldn’t, although I suspected it might have something to do with

race. Since the downfall of apartheid, in 1994, illegal backyard

funeral parlors have mushroomed in the black townships, and my

sources couldn’t discount the possibility that these outfits were

scoring their coffins from the underground economy. So, I called a

black-owned firm, Mmabatho Coffins, but it had gone out of business,

along with some others I tried calling. This was getting seriously

weird. The death rate had almost doubled in the past decade,

according to a recent story in South Africa’s largest newspaper.

“These aren’t projections,” said the Sunday Times. “These are the

facts.” And if the facts were correct, I thought, someone somewhere

had to be prospering in the coffin trade.

Further inquiries led me to Johannesburg’s derelict downtown, where a

giant multistory parking garage has recently been transformed into a

vast warren of carpentry workshops, each housing a black carpenter,

set up in business with government seed money. I wandered around

searching for coffin makers, but there were only two. Eric Borman

said business was good, but he was a master craftsman who made one or

two deluxe caskets a week and seemed to resent the suggestion his

customers were the sort of people who died of AIDS. For that, I’d

have to talk to Penny. Borman pointed, and off I went, deeper and

deeper into the maze. Penny’s place was locked up and deserted.

Inside, I saw unsold coffins stacked ceiling-high, and a forlorn

CLOSED sign hung on a wire.

At that moment, a forbidden thought entered my brain. This may sound

crazy to you, thousands of miles away, but put yourself in my shoes.

You live in Africa – OK, in the post-colonial twilight of

Johannesburg’s once-white suburbs, but still, close enough to the

AIDS front line. For years, experts tell you that the plague is

marching down the continent, coming ever closer. At first nothing

happens, but there dawns a day when the HIV estimates start rising

around you, and by 2000 the newspapers are telling you that one in

five adults on your street is walking dead.

This has to be true, because it’s coming from experts, so you start

looking for evidence. Laston, the gardener at Number 10, is

suspiciously thin, and has a hacking cough that won’t go away. On the

far side of the golf course, Mrs. Smith has just buried her beloved

servant. Mr. Beresford’s maid has just died, too. Your cousin Lenny

knows someone who owns a factory where all the workers are dying.

Your newspapers are regularly predicting that the economy will surely

be crippled, and schooling may soon collapse because so many teachers

have died.

But then you find yourself staring into Penny’s failed coffin

workshop and you think, Jesus, maybe something is wrong here…

Is this likely? Look, I believe that AIDS exists and it’s killing

Africans. But as many as all the experts tell us? Hard to say. In my

suburb, I can assure you, people’s brains are so addled by death

propaganda that we automatically assume almost everyone who falls

seriously ill or dies has AIDS, especially if they’re poor and black.

But we don’t really know for sure, and nor do the sufferers

themselves, because hardly anyone has been tested. “What’s the

point?” asks Laston, the ailing gardener. He knows there’s no cure

for AIDS, and no hope of obtaining life-extending anti-retrovirals.

Last winter, he came down with a bad cough, and everyone said it was

AIDS, but it wasn’t – come summer, Laston got better. Then Stanley

the bricklayer became our street’s most likely case. Stan maintained

he had a heart condition, but behind his back, everyone was

whispering, “Oh, my God, it’s AIDS.” But was it? We had no idea. We

were playing a game, driven by hysteria.

No one wanted to hear this. Worried friends slipped newspaper

clippings into my mailbox: CEMETERY OVERFLOWS…. HOSPITALS

OVERWHELMED…. PRISON DEATHS UP 535 PERCENT. I checked out all the

evidence, but often there was some other possible explanation, like

cut-price burial plots or a TB epidemic in the overcrowded jails or a

funding crisis in government hospitals. After months of this, even my

mother lost patience. “Shut up!” she snapped. “They’ll put you in a

straitjacket.” Mother knows best, but I just couldn’t get those

numbers out of my head: 294,703 registered deaths in 1996, 343,535

four years later. I called my friend the AIDS epidemiologist and

said, “Listen, I am beset by demons and heresies, can you not save

me?” So we had lunch, and I aired my doubts, whereupon he pointed in

the direction where truth lay, and I set out to find it.

3. A Bell is Rung

And here we are on a hilltop on the equator, overlooking the

landscape where Africa’s first recorded outbreak of AIDS took place.

It’s a village called Kashenye, which lies on the border between

Uganda and Tanzania, close to where the Kagera River flows into Lake

Victoria. In 1979 or thereabouts, according to local legend, a trader

crossed the river in a canoe to sell his wares in Kashenye. Business

done, he bought some beers and relaxed in the company of a village

girl. Some time later, she fell victim to a wasting disease that

refused to respond to any known medication, Western or tribal.

Not long after, according to Edward Hooper in his book Slim, a

similar drama unfolded in Kasensero, a fishing village over on the

Uganda side of the river. There the first victim was also a local

girl, and the agent of infection was said to have been a visitor from

Kashenye. In due course, several more citizens of Kashenye contracted

the wasting disease. Their neighbors cried foul, accusing Kashenye of

putting a hex on them. Kashenye responded with similar allegations.

Soon, villagers on both banks of the river were discarding objects

brought from the other side, believing them to be bewitched. But

nothing helped. By 1983, the contagion was in all the cities on the

Western shore of Lake Victoria. Within a few years the region became

known as the epicenter of Africa’s AIDS epidemic, and Ugandan

president Yoweri Museveni was predicting that “apocalypse” was

imminent.

His prophecy was based largely on testing done among small groups of

high-risk subjects. Many factors were unknown, however, including the

true extent of infection in the general populace, the rate at which

it was spreading, the speed at which it killed. To formulate an

effective battle plan, AIDS researchers desperately needed more data

in these areas.

They cast around for a place to study, and lit on the Masaka district

in Uganda, a ramshackle area just west of Lake Victoria and probably

100 miles north of Ground Zero. The rate of infection there among

adults was not particularly high – just more than eight percent – but

there were other considerations making it a good place to study: The

district was politically stable, and there was an international

airport three hours away. In 1989, a Dutch epidemiologist named Daan

Mulder began to lay the groundwork for what would ultimately become

the longest and most important study of its kind in Africa.

Assisted by an army of field workers, Mulder drew a circle around

fifteen villages outside Masaka and proceeded to count every

resident. Then he took blood from all those who were willing – 8,833

out of 9,777 inhabitants – screened it for HIV infections and sat

back to see what happened. Every household was visited at least once

a year, and every death was noted and entered into Mulder’s database,

along with the deceased’s HIV status.

The first results were published in 1994, and they were devastating.

The HIV-infected villagers of Masaka were dying at a rate fifteen

times higher than their uninfected neighbors. Young adults with the

virus in their bloodstream were sixty times more likely to perish.

Overall, HIV-related disease accounted for a staggering forty-two

percent of all deaths. The AIDS dissidents were crushed, HIV theory

was vindicated. “If there are any left who will not even accept

[this],” commented the U.S. Centers for Disease Control upon the

release of the results, “their explanation of how HIV-seropositivity

leads to early death must be very curious indeed.”

Clearly, only a fool would second-guess such powerful evidence, so I

just visited the villages where Mulder’s work was done, verified what

he’d found and headed back toward the airport, my story about Mbeki’s

stupidity back on track. But on my way I spent an hour or two in

Uganda’s Statistics Office, and what I learned there changed things

yet again.

In 1948, Uganda’s British rulers attempted a rough census in the

Masaka area and concluded that the annual death rate was “a minimum

of twenty-five to thirty per thousand.” A second census, in 1959, put

the figure at twenty-one deaths per thousand. By 1991, it had fallen

to sixteen per thousand. Enter Daan Mulder with his blood tests,

massive funding and armies of field workers. He counted every death

over two years, and then five, and here is his conclusion: The crude

annual death rate in Masaka, in the midst of a horrifying AIDS

plague, was 14.6 per thousand – the lowest ever measured.

I was relieved to discover that there was another possible

interpretation of these statistics. Daan Mulder’s work began at a

time when Uganda was emerging from two decades of terror and chaos.

Doctors had fled the country, hospitals had collapsed and nobody kept

track of mortality trends in the dark years of the Seventies and

Eighties. According to British statistician Andrew Nunn, one of

Mulder’s collaborators, disease-related rates must have fallen to

all-time low levels in the Seventies, when no one was counting, and

then surged massively with the advent of AIDS around 1980.

“In fact,” says Nunn, “evidence suggests it’s epidemic.” (Mulder

himself cannot be asked to explain his findings – he has since died

of cancer.)

Nunn’s explanation may be so, but the same can’t apply to neighboring

Tanzania, which embarked in 1992 on an even larger mortality study.

Like Mulder’s, it was funded by the British government and supported

by scientists from the British universities. The Adult Morbidity and

Mortality Project recruited 307,912 participants, each of whom was

visited at least once a year in the next three years and questioned

about recent deaths or disease. The final results were rather like

Masaka’s: AIDS was the leading reported cause of adult mortality, but

the average death rate in the communities studied was 13.6 per

thousand – ten percent lower than the death rate measured in the

census of 1988, which was rated “close to 100 percent” complete by

Dr. Timaeus, the UNAIDS consultant. Timaeus is a leading authority on

African mortality in the AIDS era, and it was to him that my

difficult question ultimately fell.

Professor Timaeus,” I said in his London office, “this study appears

to show that there was no increase in the death rate between 1988 and

1995, in the heart of Tanzania’s AIDS epidemic.”

He shrugged. “This survey covered only part of the country,” he said.

“True,” I said, “but a fairly large part, with hundreds of thousands

of participants.”

“But were they representative?” he countered.

I had no idea. Timaeus smiled and said, “I think this is the more

critical evidence.”

Whereupon he produced a sheath of graphs and papers and laid them on

the table. There was, he said, a “regrettable” lack of knowledge

about mortality trends in Africa, attributable to “inertia,”

indifference and a crippling lack of up-to-date data. These factors

bedeviled the demographer, but Timaeus said he knew of several ways

around them, most dramatic of which is the so-called sibling-history

technique of mortality estimation. It works like this:

Since 1984, researchers financed by the U.S. Agency for International

Development have conducted detailed health interviews with several

thousand mothers in developing countries worldwide. Among the

questions put to them are these: How many children did your mother

have? How many are still alive? When did the others die? Timaeus

realized that close analysis of the answers might reveal trends that

were failing to show up elsewhere. He set to work, and published the

results in the journal AIDS in 1998. “In just six years (1989-1995)

in Uganda,” he wrote, “men’s death rates more than doubled.” Similar

trends were revealed in Tanzania, he reported, where “men’s deaths

apparently rose eighty percent” in the same period.

Again, this seemed to settle the matter, but again, there were

puzzling complications. For a start, Timaeus’ study coincided with

Daan Mulder’s epic mortality study, which ran for seven years without

detecting any significant change in the death rate. The same is true

of Tanzania’s giant adult-mortality survey, which fell in the heart

of the period when Timaeus says male mortality was surging upward but

which failed to document any such thing.

Could there have been some problem with Timaeus’ data? Kenneth Hill

is the Johns Hopkins university demographer who helped conceive the

sibling-history technique. Recently, he and his team embarked on a

worldwide evaluation of its performance in the field, to check on its

accuracy. Last year, an article co-authored by Hill reported that the

method was prone to something called, “downward bias” – meaning that

people remember recent deaths pretty clearly, but those from years

back tend to fade. According to the article, which appeared in

Studies in Family Planning, this usually leads to a false impression

of rising mortality rates as you near the present. This has happened

even in counties where there was little or no AIDS. In Namibia, for

instance, the sibling method detected a 156 percent rise in the

fourteen years prior to 1992, when the country’s HIV infection rate

ranged from zero to one percent. “This lack of precision,” Hill and

his associate wrote, “precludes the use of these data for trend

analysis.”

“I disagree,” said Timaeus, who believes they got their math wrong.

Neither Hill nor any members of his team wanted to respond on the

record, but I drew one of them into a conversation on another subject.

“Do you accept the high levels of HIV infection being reported by

Geneva?” I asked.

“I don’t have much faith,” he said. “It’s essentially a modeling

exercise, and the exercise has always seemed to have a political

dimension.”

That rung a bell. I was living in Los Angeles in 1981, when the very

first cases of GRID were detected. I knew men who were stricken, and

I sympathized entirely with their desperation. They wanted government

action and knew there would be little as long as the disease was seen

as a scourge of queers, junkies and Haitians. So they forged an

alliance with powerful figures in science and the media and set forth

to change perceptions, armed inter alia with potent slogans such as

“AIDS is an equal-opportunity killer” and “AIDS threatens everyone.”

Madonna, Liz Taylor and other stars were recruited to drive home the

message to the straight masses: AIDS is coming after you, too.

These warnings were backed up by estimates such as the one issued by

the CDC in 1985, stating that 1.5 million Americans were already

HIV-infected, and the disease was spreading rapidly. Dr Anthony

Fauci, now head of the National Institute of Allergic and Infectious

diseases, prophesied that “2 to 3 million Americans” would be

HIV-positive within a decade. Newsweek’s figures in a 1986 article

were at least twice as high. That same year, Oprah Winfrey told the

nation that “by 1990 one in five” heterosexuals would be dead of

AIDS. As the hysteria intensified, challenging such certainties came

to be dangerous. In 1988 New York City Health Commissioner Stephen C.

Joseph reviewed the city’s estimate of HIV infections, concluded that

the number was inaccurate and halved it, from 400,000 to 200,000. His

office was invaded by protesters, his life threatened. Demonstrators

tailed him to meetings, chanting, “Resign, resign!”

In hindsight, Dr. Joseph’s reduced figure of 200,000 might itself be

an exaggeration, given that New York City has recorded a total of

around 120,000 AIDS cases since the start of the epidemic two decades

ago. In 1997, a federal health official told the Washington Post that

by his calculation, the true number of HIV infections in the United

States back in the mid-Eighties must have been around 450,000 – less

than one-third of the figure put forth at the time by the CDC.

If the numbers could be gotten so wrong in America, what are we to

make of the infinitely more dire death spells cast upon the

developing world? In 1993, Laurie Garrett wrote in her book The

Coming Plague that Thailand’s AIDS epidemic was “moving at

super-sonic speed.” It has stalled at just below two percent,

according to UNAIDS. In 1991 All India Institute of Medical Sciences

official Vulmiri Ramalingaswami said AIDS in India “was sitting on

top of a volcano,” but infection levels there have yet to crest one

percent. The only place where the AIDS apocalypse has materialized in

its full and ghastly glory is in Geneva’s computer models of the

African pandemic, which show millions dead and far worse coming.

Why Africa, and Africa only? I now know a possible reason. Read on.

4. “Crap!” An Expert Declares

In many ways, the story of AIDS in Africa is a story of the gulf

between rich and poor, the privileged and the wretched. Here is one

way of calibrating the abyss.

Let’s say you live in America, and you committed an indiscretion with

drugs and needles or unprotected sex a few years back, and now find

yourself plagued by ominous maladies that won’t go away. Your doctor

frowns and says you should have an AIDS test. She draws a blood

sample and sends it to a laboratory, where it is subjected to an

exploratory ELISA (enzyme-linked immunosorbent assay) test. The ELISA

cannot detect the virus itself, only the antibodies that mark its

presence. If your blood contains such antibodies, the test will

“light up,” or change color, whereupon the lab tech will repeat the

experiment. If the second ELISA lights up, too, he’ll do a

confirmatory test using the more sophisticated and expensive Western

Blot method. And if that confirms the infection, the Centers for

Disease Control recommends that the entire procedure be repeated

using a new blood sample, to put the outcome beyond all doubt.

In other words, we’re talking six tests in all, doubly confirmed.

Such a protocol is probably foolproof, but as you draw away from the

First World, health-care standards decline and people grow poorer,

meaning that confirmatory tests become prohibitively expensive. In

Johannesburg, for instance, a doctor in private practice will

typically want three consecutive positive ELISAs before deciding that

you are HIV-positive. But his counterpart in a government-sponsored

testing center has to settle for two ELISA tests.

In the annual pregnancy-clinic surveys on which South Africa’s

terrifying AIDS statistics are based, the protocol is one ELISA only,

unconfirmed by anything. In America one ELISA means almost nothing.

“Persons are positive only when they are repeatedly reactive by ELISA

and confirmed by Western Blot,” says the CDC. The companies that

manufacture ELISAs agree: The tests must be confirmed by other means.

“Repeatedly reactive specimens may contain antibodies” to HIV, one

firm’s literature says, “Therefore additional, more specific tests

must be run to verify a positive result.”

In parts of Africa, however, at least for the purpose of data

gathering, such precautions are deemed unnecessary. That’s partly

because the World Health Organization itself actually evaluates

commercial HIV tests as they come on the market. In these trials, new

tests are measured against a panel of several hundred blood samples

from all over the world. Some of the samples are HIV-positive, some

are not. The ELISAs are tested to make sure they can tell which are

which. Among the scores of brands evaluated throughout the years, a

handful have proved to be useless. But those manufactured by

established biotechnology corporations usually pass with flying

colors, typically scoring accuracy rates close to perfect.

In South Africa, such outcomes were often cited in furious attacks on

President Mbeki. “HIV tests such as the latest-generation ELISA are

now more than ninety-nine percent accurate.” reported the Weekly Mail

and Guardian. The tests have confidence levels of 99.9 percent, said

professor Malegapuru Makoba, head of the Medical Research Council.

Science had spoken, and science was unanimous: The tests were fine,

and Mbeki was a fool, according to the Weekly Mail, “trying to be a

Boy’s Own basement lab hero of AIDS science.”

It was a good line. I laughed, too, but there came a moment when it

ceased to be funny.

My education in the complexities of the ELISA test started when I

came across an article in a scientific journal published last year.

It told a story that began in 1994, when researchers ran HIV tests on

184 high-risk subjects in a South African mining camp. Twenty-one of

the subjects came up positive or borderline positive on at least one

ELISA. But the results were confusing: A locally manufactured test

indicated seven, but different people in almost every case. A French

test declared fourteen were infected.

It seemed something was confounding the tests, and the prime suspect

was plasmodium falciparum, one of the parasites that causes malaria:

Of the twenty-one subjects who tested positive, sixteen had had

recent malaria infections and huge levels of antibody in their veins.

The researchers tried an experiment: They formulated a preparation

that absorbed the malaria antibodies, treated the blood samples with

it, then retested them. Eighty percent of the suspected HIV

infections vanished.

The researchers themselves admitted that these findings were

inconclusive. Still, considering that Africa is home to an estimated

ninety percent of the world’s malaria cases, the implications of the

report seemed intriguing. I asked Dr. Luc Noel, the WHO’s

blood-transfusion-safety chief, for his opinion. He insisted there

was no cause for concern. Then he handed me a booklet detailing the

outcome of the WHO’s evaluation of commercial ELISA assays. In it, I

found two of the three tests that had been used in South America –

the very ones that supposedly went haywire, kits manufactured in

Britain and France, respectively. One was rated By WHO as

ninety-seven percent accurate, the other, ninety-eight percent.

On the other hand, I couldn’t help noticing that according to the

literature Noel had given me, the disease police apply at least five

confirmatory tests to every blood sample before such high accuracy

rates are achieved. What happens if you use just two, or one? And if

your subjects are Africans whose immune systems are often, as UNAIDS

head Peter Piot once phrased it, “in a chronically activated state

associated with chronic viral and parasitic exposure.” There may be

an answer of sorts.

The Uganda Virus Research Institute is possibly Africa’s greatest

citadel of HIV studies. Seated on a hilltop overlooking Lake Victoria

and generously funded by the British government, the UVRI employs

around 200 scientists and support personnel, runs an array of

advanced AIDS studies, tests experimental drugs, labors to produce an

AIDS vaccine and has generated scores of scientific papers during the

past decade.

In 1999, the Institute screened thousands of blood samples using

ELISA tests that have achieved excellent results in a WHO evaluation.

Test-driven in a lab in Antwerp, Belgium, one test scored 99.1

percent accuracy, while the other achieved a perfect 100. But in the

field, in Africa, it was another story entirely. There, exactly 3,369

samples came up positive on one ELISA, but only 2,237 of those (66

percent) remained positive after confirmatory testing. In other

words: a third of Ugandans who tested positive on at least one of

these supposedly near-perfect ELISAs were not carrying the virus.

What does this say about countries where AIDS statistics are based on

a single ELISA? A high-ranking source at UVRI – one who insisted on

anonymity – said that the WHO estimates for AIDS in such countries

“could be as much as one-third higher than they actually are.”

I took this up with Dr. Neff Walker, a senior adviser at UNAIDS, who

at first seemed puzzled. “The standard WHO/UNAIDS protocol calls for

two tests in countries with a higher prevalence,” he said.

But according to a WHO report, “Confirmation by a second test is

necessary only in settings where estimated HIV prevalence is known to

be less than ten percent.” This means that in countries like mine,

estimates are based on one unconfirmed test.

Dr. Walker conceded that, but said it wasn’t particularly important

given that most African counties have what he called “quality

assurance” programs in place.

“I feel,” he said, “that if a government found any evidence of too

many false positives in their testing, they would report it.

Governments would like to find evidence of a lower prevalence, as

would we all, and since they have the data to easily check your

hypothesis, they would do so and report it.”

But would they? High AIDS numbers are not entirely undesirable in

poverty-stricken African countries. High numbers mean deepening

crisis, and crisis typically generates cash. The results are now

manifest: plane loads of safari scientists flying in to oversee

research projects or cutting-edge interventions, and bringing with

them huge inflows of foreign currency – about $1 billion a year in

AIDS-related funding, and most of it destined for the countries with

the highest numbers of infected citizens.

On the ground, these dollars translate into patronage for politicians

and good jobs for their struggling constituents. In Uganda, an AIDS

counselor earns twenty times more than a schoolteacher. In Tanzania,

AIDS doctors can increase their income just by saving the

hard-currency per diems they earn while attending international

conferences. Here in South Africa, entrepreneurs are piling into the

AIDS business at an astonishing rate, setting up consultancies,

selling herbal immune boosters and vitamin supplements, devising new

insurance products, distributing condoms, staging benefits, forming

theater troupes that take the AIDS prevention message into schools. A

friend of mine is co-producing a slew of TV documentaries about AIDS,

all for foreign markets. Another friend has got his fingers crossed,

since his agency is on the shortlist to land a $6 million safe-sex ad

campaign.

Sometimes it seemed I was the only one in South Africa who found this

odd. Dr. Ed Rybicki, a University of Cape Town microbiologist, caught

sight of part of this article while it was being prepared and found

it alarming. “Vast inflation of HIV figures by bad tests?” he wrote

in an email. “Naaaaah. The test manufacturers have done a hell of a

lot of research, which is not published because it is part of quality

control, rather than part of a global cartel conspiracy to make

Africans HIV-positive!” He allowed that there was “probably some

truth” in stories about “various factors confusing the HIV test” but

accused me of stringing them together in an irresponsible way.

“Crap!” he ultimately declared. “Utter garbage.”

I defer to Dr. Rybicki in matters of science, but his denunciation

rested on the flawed assumption that, as he wrote to me, “In South

Africa, tests are repeated, and repeat positives are confirmed by

another method, meaning there is a threefold redundancy.” Maybe

that’s how it works in universities or research labs. But when it

comes to UNAIDS statistics, one test is evidently enough.

5. Can You Wait Ten Years?

And so we return to where we started, standing over a coffin under a

bleak Soweto sky, making a clumsy speech about a sad and premature

death. Adelaide Ntsele died of AIDS, but the word didn’t appear on

her death certificate. Here in Africa, those little letters

stigmatize, so doctors usually put down something gentler to spare

the family further pain. In Adelaide’s case, they wrote TB. But her

sister Elizabeth had no such need of such false consolation. She

donned a red-ribbon baseball cap and appeared on national TV, telling

the truth: “My sister had HIV/AIDS.” As a nurse, Elizabeth had no

qualms with the doctors’ diagnosis, and she concurred with their

decision to forgo surgery and let Adelaide die. “It was God’s will,”

she says, and she was at peace with it. I was the one beset by all

the doubts.

Did Adelaide really die of AIDS? It certainly looked that way, but

she also had TB, the second-most-frightening disease in the world

today, on the rise everywhere, even in rich countries, sometimes in a

virulent drug-resistant form that kills half its victims, according

to the CIA’s recent report on infectious disease. Eight years ago,

the WHO declared resurgent TB a “global emergency,” but the contagion

continues to spread, particularly in the cluster of southern African

countries simultaneously stricken by the worst TB and HIV epidemics

on the planet. It takes a blood test to establish the underlying

presence of an HIV infection in people with TB, and at least one

scientist who knows about these things has imputed that the tests

might not be entirely reliable.

Back in 1994, Max Essex, head of the Harvard AIDS Institute, and some

colleagues of his observed a “very high” (sixty-three percent) rate

of ELISA false positives among lepers in central Africa. Mystified,

they probed deeper and pinpointed the cause: two cross-reacting

antigens, one of which, lipoarabinomannan, or LAM, also occurs in the

organism that causes TB. This prompted Essex and his collaborators to

warn that ELISA results should be “interpreted with caution” in areas

where HIV and TB were co-endemic. Indeed, they speculated that

existing antibody tests “may not be sufficient for HIV diagnosis” in

settings where TB and related diseases are commonplace.

Essex was not alone in warning us that antibody tests can be confused

by diseases and conditions having nothing to do with HIV and AIDS. An

article in the Journal of the American Medical Association in 1996

said that “false-positive results can be caused by nonspecific

reactions in persons with immunologic disturbances (e.g., systemic

lupus erythematosus or rheumatoid arthritis), multiple transfusions

or recent influenza or rabies vaccination…. To prevent the serious

consequences of a false-positive diagnosis of HIV infection,

confirmation of positive ELISA results is necessary…. In practice,

false-positive diagnoses can result form contaminated or mislabeled

specimens, cross-reacting antibodies, failure to perform confirmatory

tests…. or misunderstanding of reported results by clinicians or

patients.” These are not the only factors that can cause false

positives. How about pregnancy? The U.S. National Institutes of

Health states that multiple pregnancies can confuse HIV tests. In the

past few years, similar claims have been made for measles, dengue

fever, Ebola, Marburg and malaria (again).

But let’s put all that science aside, for a moment. Lots of people

thought it was wrong for me even to pose questions such as these,

especially at a moment when rich countries, rich corporations and

rich men were considering billion-dollar contributions to a Global

AIDS Superfund. They were brought to this point by a ceaseless

barrage of stories and images of unbearable suffering in Africa, all

buttressed by Geneva’s death projections. Casting doubt on those

estimates was tantamount to murder, or so said Dr, Rybicki, the Cape

Town microbiologist.

“AIDS is real, and is killing Africans in very large numbers,” he

wrote. “Presenting arguments that purport to show otherwise in the

popular press is simply going to compound the damage already done by

Mbeki. And a lot more people may die who may not have otherwise.”

Rybicki was right. But what are the facts? After a year of looking, I

still can’t say for sure.

When I embarked on this story, you may recall, no massive rise in

registered deaths was discernable in South Africa. A year later, I

decided to return to my point of departure to see if the discrepancy

persisted. I wrote to the country’s Department of Home Affairs, which

manages the death register, and asked for the latest numbers. In

response came a set of figures somewhat different from those

initially provided – the consequence, I am told of people who died

without any identity documents. Here is the final analysis:

Deaths registered in 1996 – 363,238.

Deaths registered in 2000 – 457,335.

As you see, registered deaths have indeed risen – not to the extent

prophesied by the United Nations, perhaps, but there is definite

movement in an ominous direction. Deaths are up across the board, but

concentrated in certain critical age groups: females in their

twenties, and males age thirty to thirty-nine.

A team of experts commissioned by the Medical Research Council has

studied this changing death pattern and found it to be “largely

consistent with the pattern predicted by [ours] and other models of

the AIDS epidemic.” Their conclusion: AIDS has become the “biggest

cause” of mortality in South Africa, responsible for forty percent of

adult deaths.

And yet, and yet, and yet, even this is not the end of our tale,

because another governmental body, Stats SA, has challenged these

findings. The Washington Post reported that the South African census

bureau called the MRC study “badly flawed,” saying “the samples were

not representative, and assumptions about the probability of the

transmission of the virus that causes AIDS were not necessarily

accurate.”

And that’s my story: enigma upon enigma, riddle leading to riddle,

and no reprieve from doubt. Local actuarial models say 352,000 South

Africans have died from AIDS since the epidemic began. The MRC says

517,000. The figure from a group I haven’t even mentioned yet, the

United Nations Population Division, is double that – 1.06 million –

and the unofficial WHO/UNAIDS projections are even higher. I have

wasted a year of my time and thousands of Rolling Stone’s

editorial-budget dollars, and all I can really tell you is that my

faith in science has been dented. These guys can’t agree on anything.

Ordinary Africans everywhere see that the scourge is moving among

them. The guide who showed me around Uganda had lost two siblings.

Our driver had lost three. On the banks of the Kagera River, where

the plague began, we met a sad old man who said all five of his

children had died of it.

But ask these people about access to health care, and they laugh

ruefully. “The coffee price is collapsing,” they say. No one has

money. We can’t even afford transport to hospital, let alone

medicine.” All across rural east Africa, doctors confirmed the

charge: no money, no medicine. Even mission hospitals now ask

patients for money.

“What can we do?” asks Father Boniface Kaayabula, who works at a

Catholic mission in rural Uganda. “We have no money, too. We must ask

people to pay, and only a very few can.”

So what do poor Africans do if they fall sick? They go to roadside

shacks called “drug stores” and buy snake oil. Chloroquine for

malaria, on a continent where that former miracle drug has lost most

of its curative power; nameless black-market antibiotics for lung

diseases, in a setting where up to sixty percent of pneumonia is

drug-resistant; penicillin for gonorrhea, administered by an amateur

“injectionist” who might be unaware that the quantity needed to knock

out the infection has risen a hundredfold in the past decade. For the

poorest of the poor, even such dubious nostrums are beyond reach.

They try to cure themselves with herbs, they fail, and they die.

What’s to be done? Dr. Joseph Sonnabend is a South Africa-born

physician who was running a venereal-disease clinic in New York back

in the early Eighties, when GRID first appeared. He became known

throughout the world as a pioneer in AIDS treatment. When President

Mbeki launched his controversial inquiry into the disease last year,

Sonnabend came home to participate, an experience he likens to

“entering hell.”

As founder of the AIDS Medical Foundation, which became the American

AIDS Research Foundation, or AmFAR, Sonnabend has no patience with

those dissidents who dispute the syndrome’s existence or HIV’s power

to cause it. But he also believes there are “opportunists” and

“phonies” whose chief skill is “manipulation of fear for advancement

in terms of money and power.” In fact, he quit AmFAR, his own group,

because he felt it was exaggerating the threat of a heterosexual

epidemic. A decade later, he’s still fighting the lonely battle for

wise policies, especially in Africa.

In Pretoria, he says, one faction argued for the bulk of available

funds to be committed to the purchase of AIDS drugs. But merely

dumping AIDS drugs into resource-poor countries is pointless,

Sonnabend argued, although he does believe there are limited

situations where they could be safely and effectively used. The

prevention of mother-to-child transmission is one; another is in

people with advanced disease where facilities to adequately monitor

the use of drugs are in place. Unfortunately, the cost of

establishing an infrastructure to do this on a large scale would be

enormous, and without this hardly anyone would benefit, save drug

manufacturers.

The answer, he feels, is to eliminate conditions that render Africans

vulnerable to HIV in the first place. A year down the line, Sonnabend

is still trying to organize an international conference to discuss

the disposition of the money lodged in the Global AIDS Superfund. The

way he sees it, $1 billion a year would be enough to transform the

lives of ordinary Africans and curb the AIDS epidemic, but only if

it’s not squandered on unsustainable “drugs into people” programs.

“There’s a place for AIDS drugs and prevention campaigns,” he says,

“but it’s not the only answer. We need to roll out clean water and

proper sanitation. Do something about nutrition. Put in some basic

health infrastructure. Develop effective drugs for malaria and TB and

get them to everyone who needs them.”

On the other hand, we have researchers like the ones from Harvard

University who insist that biomedical intervention is morally

inescapable. “We can raise people from their deathbeds,” said

professor Bruce Walker. They calculated that it should be possible to

provide Africans with AIDS drugs for as little as $1,100 a year.

Granted, says Sonnabend, but this makes little sense if that one

lucky person’s neighbors are dying for lack of medicines that cost a

few cents.

So who’s right? Depends on the numbers, I guess. In the end, I

attempted to bring all my unanswered questions on that topic to the

man who was there when the epidemic first hit this continent, Dr.

Peter Piot, who has today risen to the role of chief of UNAIDS.

But my call to him was directed instead to UNAIDS’ chief

epidemiologist, a physician named Dr. Bernhard Schwartlander.

The UNAIDS computer model of Africa’s epidemic is in fact completely

dependable, Dr. Schwartlander says because it relies on a “very

simple formula. You take the pregnancy-clinic numbers. You take the

median survival time – around nine years in Africa. You say this is

roughly the distribution curve. Calculation of deaths is completely

plausible if – and this is important – you have a good idea of the

prevalence of HIV and how it spreads over time.”

Why then, I asked, do we have so many different estimates of AIDS

deaths in South Africa?

“I’m not shocked,” he said. “The models may completely disagree at a

particular point in time, but in the end the curves look incredibly

similar. They’re goddamn consistent.”

If that’s true, I said, then why would we have 457,000 registered

deaths here last year when the UN says 400,000 of them died of AIDS?

One of those numbers must be wrong.

“You say there are 457,000 registered deaths in South Africa?”

Schwartlander said, momentarily nonplussed. “This is an estimate

based on projections.”

No, said I, it’s the actual number of registered deaths last year.

“We don’t really know,” he replied. “Things are moving very fast.

What is the total number of people who actually die? For all we know,

it could be much higher. HIV has never existed in mankind before, and

there’s no anchor point set in stone.” The UNAIDS numbers are, after

all, only estimates. We are not saying this is the number. We are

saying this is our best estimate. Ten years from now, we won’t have

these problems. Ten years from now, we’ll know everything.”

Ten years! Had I known, I could have saved myself a lot of grief. For

even as I tried to track down the old numbers, bigger new ones were

supplanting them – 17 million Africans dead of AIDS and 25 million

more with HIV, UNAIDS now estimates; not one in five South African

adults infected but one in four. Are these numbers right? Who knows?

Rian Malan is the author of “My Traitor’s Heart: A South African

Exile Returns to Face His Country, His Tribe and His Conscience.”

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