UNAIDS image of Africa: "Almost 30 million Africans now have HIV/AIDS."
afrol News, 29 January - A growing number of researchers question the "official" inflated numbers of HIV/AIDS prevalence in African countries such as Botswana, South Africa and Lesotho. Poor testing, a special diagnosis of AIDS in Africa and erroneous computer-generated estimates by the UN had led to "misleading" numbers, they hold. The history of AIDS in Uganda serves as proof.
The Austrian specialist of reproductive medicine, Christian Fiala, leads the growing group of researchers questioning the extent of the AIDS disaster in Africa. He holds that - while there indeed is a worrying prevalence of HIV on the continent - the numbers presented by the UN agency UNAIDS and national health authorities are highly inflated.
Mr Fiala, in a recent reader's letter to the prestigious 'British Medical Journals', calls for "sense, not hysteria" regarding the AIDS epidemic in Africa. The claimed high numbers of victims to the epidemic were only "based on estimates and certain assumptions," he holds. Fellow researchers hold that the Austrian researcher and the British journal are "courageous" just for publishing the critique.
Already in 1994, a study published in the 'Journal of Infectious Diseases' had concluded that the HIV tests used were "possibly not sufficient for the diagnosis of HIV infection in Central Africa." This unreliability of HIV tests, according to Mr Fiala, had later been "confirmed" in several newer medical research studies.
- In Africa in particular, writes Mr Fiala, "people have a high number of antibodies against infectious diseases or against foreign proteins after receiving blood or dirty injections. Some of these antibodies may lead to a false positive HIV test."
But among the millions of Africans given the diagnosis AIDS, only very few have actually been tested by these "unreliable tests". AIDS diagnosis on the continent with the highest prevalence is done by other standards than elsewhere, something that the World Health Organisation (WHO) had decided on in 1985, given the high costs of testing.
According to the WHO's Africa definition, "AIDS is diagnosed on the basis of non-specific clinical symptoms and without an HIV test," Mr Fiala says. Even today, "people with for example continuous diarrhoea, weight loss and itching are declared to be suffering from AIDS. But also the typical symptoms for tuberculosis - fever, weight loss and coughing - are officially considered to be AIDS, even without an HIV test," holds the Austrian specialist.
- In order to get a total estimate of AIDS cases, WHO at it's headquarters in Geneva adds the registered AIDS sufferers to a high number of unreported cases, which WHO presumes to have occurred, explains Mr Fiala. "Thus in November 1997, the WHO announced that since its previous report in July 1996, there had been a further 4.5 million AIDS cases in Africa. In this period, however, only 120,000 AIDS sufferers were actually registered."
Further proof for what the critics of the 'AIDS pandemic' call "misleading" prevalence numbers was given by the case of Uganda. Ten years ago, Uganda was internationally recognised as the country worst struck by the disease, with local prevalence rates reaching 30 percent. Now, the Kampala government celebrates itself as an example of how to fight AIDS, claiming that its energetic campaigns had turned the tide.
Mr Fiala considers the Ugandan success story a bluff, assuming that AIDS prevalence never could have been as high as originally claimed. Poor testing methods and failed statistics had inflated the numbers.
He finds proof in Uganda's newest population census and household surveys. During the last decade, the assumed high AIDS prevalence of the early 1990s should have led to increased mortality in Uganda. This is not the case. The country's mortality rate has in fact declined, especially due to lower infant and childhood mortality rates. Uganda's population now grows at an average annual rate of 3.4 percent - the highest ever.
Further, he contradicts Ugandan government claims that the numerous campaigns against AIDS could have led to a change in sexual behaviour and thus to a fall in HIV infections. The national household survey of 2002 shows that Ugandan girls have the same sexual behaviour as they had ten and thirty years ago. Further, protection against AIDS has not improved - only 2 percent of Ugandan women regularly use a condom.
The South African writer Rian Malan in a recent article in the UK-based 'Spectator' makes similar conclusions regarding the AIDS pandemic in Southern Africa. In his article "Africa Isn't Dying of AIDS," Mr Malan reacts to UNAIDS claims that almost 30 million Africans now have HIV/AIDS.
- But, says Mr Malan, "the figures are computer-generated estimates and they appear grotesquely exaggerated when set against population statistics." In Botswana, the country with the world's highest AIDS prevalence, several reports had suggested that population had dropped from 1.4 million in 1993 to under a million currently, due to the AIDS pandemic.
Not true, says Mr Malan. "Botswana has just concluded a census that shows population growing at about 2.7 percent a year, in spite of what is usually described as the worst AIDS problem on the planet. Total population has risen to 1.7 million in just a decade. If anything, Botswana is experiencing a minor population explosion," the South African writer concludes.
He continues slaughtering UN and national statistics on South African AIDS deaths. UNAIDS is using a computer simulator called Epimodel to estimate AIDS related deaths, which had produced estimations of 250,000 AIDS deaths in South Africa in 1999 alone.
South Africa however, unlike all other African countries, has reliable mortality reporting. Pretoria data showed that total deaths - of all kind of causes - in South Africa had been 375,000 in 1999 - "far too few to accommodate the UN's claims on behalf of the HIV virus," Mr Malan notes.
A South African study based on local mortality data thus reduced the number of estimated lethal victims of AIDS to 143,000 - still representing 40 percent of all deaths in 1999. Later studies resulted in two more downwards regulations of the assumed AIDS deaths in South Africa in 1999. Current estimates are of an AIDS death toll somewhere around 65,000 for that year - "a far cry indeed from the 250,000 initially put forth by UNAIDS," Mr Malan comments.
Local South African studies, where population segments have been HIV tested, according to Mr Malan show a far lower prevalence than official estimates. At a university in KwaZulu-Natal, HIV prevalence was only one ninth of the expected number and bank employees had one forth of the expected HIV prevalence. Mr Malan believes that the picture is equal in other African countries, where UNAIDS estimations are used.
Paul Bennell, a health policy analyst at Sussex University's Institute for Development Studies (UK), agrees. After the BBC in November 2002 had reported that "one in seven" of Malawian teachers would die of AIDS in that year alone, Mr Bennell looked at the available mortality evidence from Malawi.
His 2003 study 'Teacher mortality at primary and secondary schools in Malawi 1997-2002' found actual teacher mortality to be "much lower than expected". In Malawi, for instance, the all-causes death rate among schoolteachers was under 3 percent, not over 14 percent as the UN's computer-generated estimates had suggested.
Further, teachers' mortality in Malawi appeared to "have peaked in 1999 and 2000," Mr Bennell found. "The epidemic is not growing in most countries," insists the British scientist. "HIV prevalence is not increasing as is usually stated or implied," he concludes.
Mr Bennell regrets that "there is virtually no population-based survey data in most of the high-prevalence countries, including Botswana, Ethiopia, Malawi, Lesotho, Namibia and Swaziland."
In Lesotho, for example, UNAIDS' computer-generated estimates have shown dramatic increases in HIV prevalence without testing of the population. While UNAIDS estimates put HIV prevalence at 8.4 percent in Lesotho in 1997, this boomed to 23.6 percent in 1999 and 32 percent in 2001. The numbers have never been tested in real life, however.
For the growing number of sceptical scientists, the allegedly "misleading" UNAIDS numbers come at a high price for Africans. Mr Fiala regrets the "fatal consequences" of these numbers. "Thus for example, UNAIDS 1999 recommended Finance Ministers in the African countries cut their budgets for social security, education, health, infrastructure and rural development in order to have more funds available for the fight against AIDS," he notes.
Also Mr Malan fears the consequences of this "error". It gives the false impression "AIDS is the only problem in Africa, and the only solution is to continue the agitprop until free access to AIDS drugs is defined as a 'basic human right' for everyone."
Meanwhile, he holds, a far greater number of Africans are dying from diseases that are cured at a much lower cost, such as malaria and tuberculosis (TB) and research on these diseases is suffering. "Two million get TB, but last time I checked, spending on AIDS research exceeded spending on TB by a crushing factor of 90 to one," he notes. He now urges to "start questioning some of the claims made by the AIDS lobby."
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