Africa and the AIDS Debate
Addis Tribune, August 11, 200
By Allehone Mulugeta
"What is truth?" asked Pilate centuries back when he was confounded with the depth of the elusiveness of the 'the true words'. In science, at least, conventionally doubting is an organizing principle of knowledge where laws are abstracted from a number of trials and experimentation. But even among science gurus who claim to subscribe to this principle, such a thinking structure sometimes emerges lacking, and assumptions and presuppositions predominate pseudo-scientific inquiry.
In our daily life, it is quite normal and perhaps human to make our own assumptions and positions and neglect the way of the rational. HIV/AIDS has been an issue on which even the most efficient and able scientists of our planet have fallen to that principal human predicament.
At the 13th International Conferences on HIV/AIDS that took place in Durban, South Africa, recently, all sort of interest groups have gathered to make their regular deliberation on the state of HIV/AIDS. In this international forum, the South African President Tabo Mbeki has challenged the participants to rethink some of the assumptions about HIV.
Given the magnitude of its destructiveness and the attention it gained from governments, NGOs, international organizations and individuals, many are not content with the wealth of knowledge we were able to have collected over the past few decades.
Despite the awesome money transfer for the cause of AIDS to Africa from Western NGOs, Africans are under the shadow of ignorance, uncertainties and confusion regarding this fatal disease which is hitting them harder than it does any member of the family of the human race. AIDS's brutality in Africa makes it necessary for Africans to have the weapon with which they can fight against this disaster and salvage their future which is marred with uncertainties.
Now AIDS has become an African pandemic as more than 24 million people are infected with this disease. Southern, Central and Eastern parts of the continent are where AIDS has an exaggerated prevalence and South Africa, Botswana, Zimbabwe,
Mozambique, Ethiopia and others are crisis sites where the worst scenario is manifesting itself. In South Africa, according to the Johannesburg's Mail and Guardian, 60% of the armed forces may have HIV/AIDS. In addition to creating a national insecurity at home, this may affect the international peacekeeping capabilities of the South African military since HIV-test positive soldiers cannot take part in international peace-keeping units. In two African cities, Francistown, Botswana, and Harare, Zimbabwe, 40% of women attending antenatal clinics are HIV infected. Ethiopia rated top in hosting AIDS orphaned children. In Zambia, 65% of the households where the mother had died, the children usually go to relatives to live with them. In Cote d' Ivoire, HIV prevalence among the general population has already reached 13% and unless this growth is arrested the epidemic will affect 16% of the population by the year 2010. In a few years' time the economy of these African countries would seriously be threatened unless effective and efficient measures are taken. In Hans Binswanger's (a World Bank economist) word "Africa is burning". Only in few hard-hit Southern African countries, the national wealth will be reduced by 10-15% in the next ten years.
With its apocalyptic presence, HIV/AIDS is a matter of survival for the African society and it is a massive challenge that equals slavery or the colonial encounter, if not surpass them. At the dawn of this century, African leadership need to ensure that Africa survives this natural and historical blunder. In its 2000 report under the title "Can Africa Claim the 21st Century?", the World Bank identifies lack of political commitment and will as a major hurdle in fighting AIDS. African governments hence need to make a periodic survey of HIV's prevalence, work out feasible and cost-effective projects and make an effective intervention for implementation of policies. It is only governments, which have the mandate and the means to finance the public goods that are necessary for the monitoring and control of the disease-epidemiological surveillance, basic research on sexuality, information collection and dissemination and the evaluation of cost effectiveness of intervention. As Callisto Madavo, vice-president of the World Bank's African region, noted at the 13th International AIDS conference, AIDS "above all, is a matter of commitment. The sobering reality is that AIDS is not a health problem, but a serious development issue. Only where governments show leadership can international support be effective".
But this is a tough and arduous road for African governments. Results of governmental measures take years to be seen and in most countries the prevalence of the disease is so awesome that it could easily frustrate governments. Only in those countries with nascent epidemics like Cape Verde, Madagascar, Mauritania, Mauritius and Somalia does a unique chance for an effective intervention on the part of the government exist. Among countries which have high AIDS prevalence, Uganda and Senegal have shown a remarkable success where particularly in the case of the latter HIV growth rate is kept at 1.8 percent. The small number of the HIV-positive individuals allows the government to consider using treatment schedules that otherwise would not have been affordable.
Of course this is all conventional wisdom on HIV/AIDS in Africa and what governments should do about it. For the South African President Tabo Mbeki, however, this is not enough. If we need his counsel, Mr. Mbeki is urging Africans to transcend their limitations and rethink the basics of the disease. For Mbeki, this experience is validated in his own personal struggle to outgrow his inhibitions. When he took the mantle from Mandella, many accused him of shying away from HIV in a country where 22.8% of the pregnant women are dying from the virus and only making wooden speeches. But to the surprise of many, he has now emerged at the center of a great debate that may shape the future discourses. Great debates on AIDS have always centrally involved Africa.
The theory that AIDS started in Africa when Wistar Institute experimented its CHAT polio vaccine in Belgium Congo where the vaccine was grown on a Chimpanzee kidney remains as scientifically plausible and verifiable as it has always been. In his newly published book The Rivers: A Journey Back to the Source of HIV and AIDS (Little Brown: 1.104 Pages $34 2000). Edward Hooper blasted the scientific community with his thesis that the most prevalent form of AIDS, the sort causes by the virus family known as HIV-I group M, was introduced during vaccine trials in the 1950s and 1960s in Africa through CHAT, a polio vaccine produced by Wistar Institute in Philadelphia by a researcher Hilary Hoprowski. For Mr. Hopper one or more batches of CHAT are sill safely on ice in the Institute's freezers where they could be identified and tested. Why was this vaccine trail attempted in Africa? He could easily pick up the answer because in Africa poor volunteers are readily available. While this debate is still hot, Mr. Mbeki is coming with another.
The point the South African president is making to the world at large in general and the scientific community in particular is that little is known about HIV and AIDS connections, the means of diagnosing the disease and its relation with TB and other diseases and there is uncharted dimension to the mystery. But in asking the basics he played the unorthodox and was attacked both by the media and the medical gurus who, according to him, "scarified all intellectual integrity to act as salesperson of the product of one Pharmaceutical company (AZT manufacturer, Glxo Wellcome". Of course these voices of criticism are coming from the main stream against Mbeki's 'Expert Panel of Inquiry' which is consisting of dissident scientists who do not accept some orthodox views on AIDS. Why is the South African President involved in such a controversial project? In fact what he is doing is a logical outworking of a leadership culture that is built on a strong political will to make a difference to the constituency.
The Panel under his Office's auspices is to conduct a research that is going to have great impact on HIV/AIDS issue in Africa in particular and the world in general. Up to now Mbeki had already secured the membership of prominent scientists who have been feared and also pushed by the mainstream. One confirmed member of the Panel, South African Professor Sam Mhlango, says, "My view is that the case for a link between HIV and AIDS is not proven and I have a question over the diagnosis of AIDS itself". This is a search for the truth without being blinded by conventional truths and myths initiated by President Tabo I Mbeki is the most rational, says another Dr. Andrew Herxheimer from Cohrene Institute. Some of the outstanding issues that are to be addressed by this batch of experts are to answer the questions whether Africa should keep on soliciting money to buy expensive and increasingly toxic drugs, whether we can rely on the received "truth" that HIV causes AIDS and what to make of the attachment AIDS has with TB and other diseases.