Professor Charles Geshekter
Department of History
California State University, Chico
Paper presented 1st June 2006 at the 5th Annual Conference of the Historical Society, University of North Carolina
Below are two extracts from:
The Globalisation of AIDS:
On Using History to Critique Public Health Hysteria
The full article (PDF) can be downloaded here
Extract 1
AIDS researchers in Africa assume there is a correlation between clinical symptoms (weight loss, chronic diarrhea, fever, a persistent dry cough) and sexual activity. Correlation - whether one phenomenon is found in tandem with another - is not causation. Proof of causation requires that we control all variables in order to isolate one variable as a cause, not merely as an associated factor. The clinical symptoms that define an AIDS case in Africa are expressed in roughly equal numbers among men and women, not because of alleged heterosexual transmission, but because the socio-economic conditions that give rise to the gender equity in the distribution of these widespread symptoms are caused by environmental risk factors to which many Africans are regularly exposed.
Moreover, there may be a correlation between having those clinical symptoms, which attest to an absence of good health, and the likelihood that the patient will generate a positive antibody test result. This does not prove that it was the antibodies (or "HIV") which caused those symptoms. Anyone who has those symptoms, which are due to environmental insults, may cause a positive test result, indicating simply that the patient is likely to be in poor health. To put it another way, the presentation of the clinical AIDS symptoms is likely to predict a positive HIV-antibody result on a single ELISA test. Thus, these AIDS symptoms could be said to "cause" a positive test result.
Poverty-stricken, malnourished subsistence farmers with malaria, tuberculosis or repeated attacks of dysentery are likely to have a considerable amount of cross-reacting antibodies in their systems. Dr. F.J.C. Millard, a physician at a small mission hospital in South Africa’s North Province (formerly Northern Transvaal), described the local conditions in which the incidence of tuberculosis and AIDS were rising: “the area had suffered from neglect during the apartheid years. There is poverty, malnutrition, violence, unemployment, overpopulation, and, most important of all, a lack of education.”
Extract 2
The AIDS epidemic in Africa has been used to justify the medicalization of sub-Saharan poverty. Rather than treat the clinical symptoms of AIDS as the manifestations of impoverished living conditions, researchers like Dr. David Alnwick, UNICEF’s health chief, invert this cause-and-effect relationship to allege that “all our efforts at providing safe water and other protections for children have been undermined, undone, by the AIDS epidemic.”
Western medical intervention has taken the form of vaccine trials, drug testing and demands for behavior modification. In 1997, the Division of AIDS at the National Institute of Allergy and Infectious Diseases concluded that there was “not enough evidence that a live attenuated HIV-1 vaccine [was] safe - or effective.” Nonetheless, the International Association of Physicians in AIDS Care (IAPAC) insisted that a vaccine should not be required to meet U.S. safety and efficacy standards because the alleged number of AIDS cases rendered “further delay unethical.”
AIDS scientists and public health planners should recognize the roles of malnutrition, poor sanitation, and parasitic and endemic infections in producing the clinical AIDS symptoms that are manifestations of non-HIV insults. The data strongly suggest that socio-economic development, not sexual restraint, is the key to improving the health of Africans. Wherever one projects high rates of HIV-antibodies in Africans, one also finds high rates for all germs indicative of sanitation problems which point towards abject poverty, destitution and a high disease burden.
Quoted in David Perlman, “UN Moves to Prevent AIDS Babies,” San Francisco Chronicle (June 30, 1998).
A steady stream of AIDS researchers from the United States and Europe has converged on Africa, convinced that their work is humane and benevolent just as 19th century missionaries came to cure and train. Jonathan Falla sees this impulse towards charity as another form of social control. “What Do They Think They Are Doing?,” Times Literary Supplement (July 18, 1997).
Michael McCarthy, “AIDS Doctors Push for Live-Virus Vaccine Trails,” The Lancet, Vol. 350 (October 11, 1997), p. 1082.
This is elaborated in Charles Geshekter, "Outbreak? AIDS, Africa, and the Medicalization of Poverty," Transition, #67 (Fall 1995), pp. 4-14; Geshekter, “The Plague That Isn’t,” TorontoGlobe and Mail (14 March 2000), and Cindy Patton, Inventing AIDS (New York: Routledge, 1990), especially Chapter 4, “Inventing African AIDS.” In 1997, Glaxo-Wellcome negotiated with the South African Department of Health to have the government subsidize the cost of importing AZT. As part of this “bouquet of assistance” to provide HIV positive women with AZT, the difference in cost between the actual and discounted price would be used to fund training for “AIDS counselors.” The Weekly Mail and Guardian ( Johannesburg), August 22, 1997. Some pharmaceutical companies now urge pregnant African women who test HIV-antibody positive to take these powerful drugs and to stop breast-feeding their infants.
