TCS Daily

False Truths

By Roger Bate - March 17, 2003 12:00 AM

Among the well-known "truths" for why AIDS is such an epidemic in Africa is that Africans' sexual practices are different from Westerners. Africans have more unprotected and anal sex; they swap partners and are more bisexual; they rape women more and have sex with their own, and other peoples, children and even with monkeys.

But as it turns out, those long established "truths" just may not be so. A recent study by David Gisselquist in the International Journal of Sexually Transmitted Diseases and AIDS, concludes they are actually falsehoods, perpetuated because they are politically useful.

Dr. Gisselquist and colleagues analysed over 40 studies published between 1984 and 1988. They found that the best association with HIV infection wasn't different sexual practices, but medical injections.

Injections accounted for over 50% of all HIV associations in Africa, whereas the number of sexual partners or even blood transfusions counted for far fewer.

Back in 1988, though, the consensus view, as espoused by the World Health Organisation Global Programme on AIDS, was that 80 percent of infections were due to heterosexual transmission. Other experts put the figure as high as 90 percent.

What is most shocking about Gisselquist's research is that it suggests these figures were reached despite glaringly obvious research to the contrary.

The U.S. Agency for International Development, which promoted some of the erroneous beliefs in Africa, has already said that it will do its own analysis of the Gisselquist data.

"I have asked to see the original scientific studies. ... The epidemiology of the disease fits that it is mainly a sexually transmitted disease. I need to see the data," said Dr. Anne Peterson, a physician and head of the USAID bureau of global health said in the Washington Times in early March.

The study also has upset the normally unflappable members of the public health community. WHO and UNAIDS, have called a meeting for March 17 in Geneva to discuss the research, which threatens to discredit years of conventional condom-based programs to fight AIDS in Africa. Dr. Peterson said someone from USAID would attend the Geneva meeting as well.

The Evidence

WHO and the rest of the public health crowd are likely to be embarrassed. Between 1984 and 1988 individuals with sexually transmitted diseases (STDs), but with no indication of medical injections, had much lower rates of HIV infection than individuals with STDs receiving injections.

This association is not proof but it is indicative. More persuasive is one study that showed 40 percent of children under 2 years old who had HIV had HIV negative mothers. Another similar study showed 24 percent of children with HIV from uninfected mothers. And in both these studies the only major difference from non-infected children was that these children had received more injections than normal.

Remarkably, this most likely explanation was ignored and replaced with analysis saying that the diagnosis was in error and the children had been the victims of child abuse. As Stuart Derbyshire, an AIDS expert from Pittsburgh Medical Center, caustically put it: "Perhaps the scientists involved thought it was more likely Africans were having sex with their own children than getting infected from another source."

Gisselquist and his colleagues are obviously frustrated with current prevention policies, which have followed the narrow focus on paternalistic sex education. They claim that the motives of the AIDS researchers - whether to further their fame or funding - were initially to promote the African AIDS epidemic as a heterosexual one; to encourage the widespread distribution of condoms; to disparage the wayward sexuality of Africans; and finally to not mention the danger of transmission by needle because children's parents might refuse immunisations if they knew the truth.

"In short, tangential, opportunistic and irrational considerations may have contributed to ignoring and misinterpreting epidemiologic evidence," they concluded.

This is shocking stuff. The authors of the report claim that their findings have "major ramifications for current and future HIV control programs in Africa." If the findings are correct, it could force a major reallocation of funds that go into HIV-prevention programs.

New solutions?

USAID is obviously worried since it will be responsible for distributing much of President Bush's proposed $15 billion five-year initiative to combat AIDS in Africa. There are more than 28 million people in Africa with HIV, and USAID has already spent $2.3 billion of U.S. taxpayers' money in AIDS prevention and treatment since 1986, much of it on condoms, including over $25 million on condoms last year alone.

Medical infrastructure - or, more precisely, a lack thereof - has always been a major cause of the spreading of AIDS and other diseases. It appears that combating this failing, by providing doctors and nurses competent in providing injections, and clean syringes and needles for those injections, may be the best way to help reduce new AIDS cases in Africa.

No doubt there are errors in the Gisslequist report. I expect them to be played up for all they are worth. But overall the analysis looks pretty strong. And we should not be surprised that Gisselquist has found that HIV in Africa is not so different to HIV elsewhere. It is difficult to catch outside of high-risk groups such as those having injections in un-sanitised conditions.

This is actually good news. It is easier to help countries improve their medical infrastructure than lecturing about sexual mores and dispensing condoms to Catholics.

The Geneva meeting on 17th March may set AIDS prevention in a new direction, perhaps in a direction that should have been known a decade ago. We may never know how many of the millions of AIDS victims could have been saved if AIDS researchers had been more honest in the 1980s.

Dr. Roger Bate is a fellow of the International Policy Network and a columnist for

TCS Daily Archives