.
The human immunodeficiency virus (HIV) eats away at the T-cells of the body’s immune system, thereby exposing it to infections. Twenty-six diseases are now on the list of these “opportunistic” infections. Some of them are not actually infectious — Kaposi’s sarcoma and cervical cancer, for example. Others are — tuberculosis, herpes, pneumonia, and candidiasis among them. So, if you have one of these diseases, and you are HIV positive, and, in time, your T-cell count dips below a certain level, then you have AIDS.
In Africa, however, the WHO — under the supervision of the CDC — put together a quite different “clinical case definition” of AIDS. It really is very different, in three crucial respects:
(1) None of the opportunistic diseases has to be present.
(2) No HIV test has to be conducted.
(3) No T-cells are counted.
This redefinition was worked out in October 1985, at a meeting in Bangui, the capital of the Central African Republic. About sixty officials were present, including Americans from the CDC who had organized the meeting. A document was produced, and the curious may view it on the web. Titled “Workshop on AIDS in Central Africa,” it spells out the medical conditions considered sufficient to identify an AIDS case in Africa. (To view it, type “Bangui1985report” without spaces into your search engine.) [1]
What prompted the meeting was the claim that AIDS or something resembling it had “recently appeared” in hospitals in Zaire and elsewhere. The “biological features of AIDS in Africa” had to be identified. That would not be easy, however. “Adequate laboratory facilities are often lacking,” as those in attendance were reminded. Instead, a “surveillance” definition was needed. It had to be “simple, universally acceptable, and usable by all health service personnel.”
Given these limitations, here is what the participants finally agreed was needed to count AIDS cases in Africa. Four “major” symptoms had been found to be associated with AIDS in the Western world:
- Weight loss of 10 percent or more
- Pronounced weakness or lack of energy (called “asthenia”)
- Diarrhea lasting for more than a month
- Fever, either prolonged or intermittent
In addition, several “minor” symptoms were often found, among them:
- A cough persisting for more than a month
- Chronic ulcerative herpes infection
- Swollen glands (called “generalized adenopathy”)
From these symptoms, a new “definition of AIDS in adults in Africa” was derived by mixing and matching from the two lists:
“AT LEAST THREE OF THE FOUR MAJOR SYMPTOMS ASSOCIATED WITH ONE OF THE MINOR SYMPTOMS” [caps in original].
That was it. There was no mention of HIV.
Overnight, millions of Africans now had AIDS, by these criteria. The definition was so broad that “almost anyone in any African hospital could be said to have it,” says Rian Malan. Let’s say you’re in the Congo. You go to a doctor because you’re feeling weak. You’ve lost weight and have had a recurring fever for a few weeks and a persistent cough. Doctors are now free to say that you have AIDS. For a child, all they need is weight loss, diarrhea, and a cough…
In Africa, “as in the United States,” the report stressed, “sexual transmission is the main way in which AIDS is spread.” No evidence was offered for that sweeping claim. Nonetheless, “in the absence of treatment or of a vaccine, health education aimed at changing sexual behavior is an essential means of controlling AIDS.”
Finally, the media was enlisted to get the word out on the threat of AIDS in Africa:
“The mass media should be urged to play a part in this health education. Media personnel could receive training for this role.”
The media duly reported whatever the authorities told them to report. Evidence gleaned from sick patients in African hospitals, physically resembling American patients, became the harbingers of a world pandemic. Pictures of emaciated Africans lying on cots were transmitted, printed, and reprinted. The sub-Saharan continent was flooded with condoms, pamphlets, and AIDS educators. Money flowed in by the boatload from aid agencies all over the world.
The new AIDS definition was reported in WHO’s Weekly Epidemiological Record [2], in CDC’s Morbidity and Mortality Weekly Report, and in Science [3]. Bit it has not been visibly reported by the major news media in the United States…
Conditions that define AIDS in sub-Saharan Africa are caused by many germs, not just HIV. And the other diseases caused by these germs also produce a “positive” result in the HIV test. Charles Gilks wrote in the British Medical Journal that persistent diarrhea with weight loss can be associated with “ordinary enteric parasites and bacteria,” as well as with opportunistic infection. “In countries where the incidence of tuberculosis is high,” he added (and it is high in Africa) “substantial numbers of people reported as having AIDS may in fact not have AIDS.” He concluded that the Bangui definition “is inherently unworkable and incorrect” [13].
[1] WHO, “Workshop on AIDS in Central Africa,” October 22-25, 1985.
[2] WHO, Weekly Epidemiological Record, No. 10, March 7, 1986.
[3] Science, November 21, 1986.
[13] Charles Gilks, “What Use is a Clinical Case Definition for AIDS in Africa?”, British Medical Journal, 303 (1991), 1190.
Tom Bethell
“African AIDS: A Political Epidemic”
Chapter 7, The Politically Incorrect Guide to Science
