Dr. Charles L. Geshekter, a notable scholar on AIDS, joins the list and offers more insights on this controversial subject. Charles has taught African history at California State University/Chico since 1968. His essay, "Outbreak? AIDS, Africa, and the Medicalization of Poverty," was the lead article in the Fall 1995 issue of Transition (Oxford University Press). His paper "AIDS, Underdevelopment, and Sexual Stereotypes: Rethinking AIDS in Africa," was presented at the XI International Conference on AIDS (Vancouver, July 1996). Revised versions were presented to the U.N. Sub-Commission on Human Rights (Geneva, August 1997) and at the General Assembly meeting of the Council for the Development of Social Science Research in Africa/CODESRIA (Dakar, Senegal, December 1998). Two articles based on that research on AIDS in Africa were published in African Agenda (Vol. 3, #2 March/April 2000): "Redefining AIDS" and "AIDS and the Medicalization of Poverty." His critical commentaries calling for a thorough reappraisal of AIDS in Africa have appeared in many newspapers including "The Plague That Isn't" (Toronto Globe and Mail, March 14, 2000), "The Epidemic of African AIDS Hysteria" (The Citizen /Johannesburg, September 16, 1998) and "Rebutting the New 'Black Plague' " (The Portland Oregonian, July 26, 1998).
To Charles, we need "a break in the relentless junk science and faux epidemiology that nowadays passes for "AIDS in Africa" work. I have long contended that we will never "cure AIDS" until we first "cure the research." It's another way of saying that the "cure for AIDS" is as near at hand as an alternative explanation as to what is making Africans sick in the first place."
I would dearly like to know more about what Pablo has been doing of late. He and I worked together in February 2000 at York University on a program to provide a critical and dissident perspective on the near-hysteria and near-absence of any second thoughts regarding AIDS in Africa that prevailed among the African Studies community.
Pablo had actually approached me at a conference in Toronto in 1999 that was all about Somalia and wanted to talk about AIDS. He invited me back to York University in February 2000 where I gave a series of lectures to largely responsive and supportive audience. Pablo also included some brave progressive women from the Feminist Health Collective who had published a pamphlet in 1999 offering a solid feminist perspective on AIDS globally with a strong dissident perspective.
I recall Pablo telling me that some faculty at the University of Toronto were horrified to hear that dissident voices would be expressed at York. When Pablo invited them to attend the session and engage in a dialogue, he was met with silence and scorn as I recall. He can probably provide you with more details.
Thanks largely to Pablo's heroic and scholarly efforts, I was contacted by the editors of the *Toronto Globe and Mail* and invited to submit an op-ed piece critiquing the doomsday dogma and quasi-racist insinuations about AIDS cases in Africa. That piece ran in the national edition of the paper (circulation 1 million) on March 14, 2000, entitled "The Plague That Isn't."
As I recall it too generated a huge silence.
At the recent ASA conference in New Orleans, I presented a very long,
heavily footnoted paper entitled "AIDS, Medicine and Public Health:
The Scientific Value of Thabo Mbeki's Critique of AIDS Orthodoxy."
My two co-authors are both physicians and, like me, were among the dissident
members of President Mbeki's AIDS Advisory Panel.
"AIDS, Medicine and Public Health:
The Scientific Value of
Thabo Mbeki's Critique of AIDS Orthodoxy"
Charles Geshekter (California State University, Chico)
Claus Köhnlein, M.D. [Kiel, Germany]
Sam Mhlongo, M.D. (National Medical University of South Africa, Pretoria)
This paper challenges the conventional wisdom that views AIDS in Africa as a microbial problem to be controlled through abstinence, behavior modification, condoms and drugs (the "ABCs" of AIDS interventions).
The narrative that shapes such interventions is rooted in a western paradigm that attributes the clinical symptoms that define an AIDS case in Africa to sexual activities.
We propose that while this "master narrative" of AIDS in Africa medicalizes poverty and sexualizes African life, it ignores the inconsistencies, contradictions and definitional flaws in the microbiology of HIV and HIV antibody tests.
The paper demonstrates that the blood tests used to detect HIV never "find" HIV, only its alleged antibodies. With all other diseases caused by a microbial agent, the presence of antibodies indicates the patient has mounted an immune response against the microbe. In violation of the core protocols of virology, HIV antibodies are said to be a predicator of a syndrome to come. The paper explains why this is clinically impossible.
Our paper disputes the statistical claims of a "sudden" eruption of HIV/AIDS in South Africa since 1990. Estimated HIV rates for South Africa are based on a single HIV antibody test administered at 100 antenatal clinics, termed "sentinel sites," for 18,000 African women. These HIV tests are notoriously unreliable because they produce ludicrously high numbers of false positive results when given to pregnant women.
The numbers of actual AIDS cases in South Africa reflect a careless use of statistical sources and questionable definitions; purported AIDS cases in South Africa are routinely conflated with HIV-antibody test results, then extrapolated to the entire population of 43 million.
Moreover, claims regarding which illnesses afflict South Africans in 2004 and which ones caused death fifteen years ago ignore how the very definition of "South Africa" dramatically changed between 1989 and 1999.
In 1989, South Africa (according to official apartheid terminology) had a total population of about 21 million. This figure excluded 6 million Africans who lived in the "TBVC states" (Transkei, Bophuthatswana, Venda and Ciskei) and excluded 8 million Africans in the six self-governing territories ("SGTs").
The overwhelming majority of the 14 million Africans in those fragmented territories were the most obvious victims of apartheid. The huge rural slums of the TBVC countries were "urban" with respect to population density but "rural" with regard to the absence of proper infrastructure or services, especially in terms of public health.
The 1989 study by Wilson and Ramphele, Uprooting Poverty: The South African Challenge showed that the depths of poverty were caused by "insufficient labour, insufficient capital and the high risk of much toil yielding little fruit." The statistical reporting on health, employment and living conditions among those 14 million Africans was systematically evasive. No one disputed that mortality and morbidity rates were significantly higher in the TBVC countries and the SGTs than in the rest of "South Africa." The Africans in those areas suffered from far higher rates of protein anemia, malaria, tuberculosis, cholera and dysentery, and their life expectancy was significantly lower than in the rest of "South Africa," as it was defined in 1989.
Our paper explains what happened when vital statistics on those 14 million impoverished inhabitants of the former rural slums (who numbered an estimated 17 million in 2000) were finally included as "citizens" in post-apartheid, unitary South Africa. Their inclusion in public health statistics reaffirmed the unhealthy living conditions that had long prevailed in the TBVC and SGT areas under the apartheid regime, not that rural South Africans were suddenly afflicted by the mysterious machinations of a novel retrovirus.
Unlike the prevailing AIDS narrative with its focus on stigma and apocalyptic images, the paper indicates how data from the social sciences and internal medicine can dispel these lurid claims.
In the impoverished, often transient communities where AIDS is a disease of the poor, the complexity of disease distribution in post-apartheid South Africa must be explained. Since his election in 1999, President Thabo Mbeki has argued that poverty and social inequality were the most potent co-factors for an AIDS diagnosis. Mbeki has been a forceful advocate for the need to redistribute resources in favor of the world's poorest; the origins of those inequalities are neither mysterious nor microbial.
Migrations in South Africa were often triggered by the imperatives of apartheid, but even after its formal dismantlement, powerful links remained between poverty, low social status and vulnerability to infections. The rigid racial segregation of health facilities, grossly disproportionate spending on the health of whites compared to blacks, public health policies that ignored diseases primarily affecting black people (malaria, tuberculosis, respiratory infections, and protein anemia), and the denial of basic sanitation and clean water supply continue to afflict the former homelands and townships.
President Mbeki continues to pose a very basic question: why is the epidemiological profile of AIDS cases in Africa decisively different than that found in the United States and Europe? The paper concludes by suggesting that an important lesson learned from answering his question is that a significant portion of the billions spent on AIDS should be diverted to poverty relief, job creation, the provision of sanitation and clean drinking water, and financial help for drought-stricken farmers.
Charles L. Geshekter
Claus Köhnlein, M.D.
Sam Mhlongo, M.D.