OUT OF AFRICA
By Celia Farber
Spin March 1993
Plagued by poverty, drought, and famine, Africa has also been burdened
with terrorinducing AIDS propaganda imported from the West. Is there
really an epidemic of AIDS in Africa? Celia Farber reports.
Clinic of Infectious Diseases, Treichville Hospita1, Abidjan, Cote
We asked if we could please see the AIDS wards. The doctor, Aka Kakou,
removed his glasses. "You want to see the wards?" he repeated.
"Yes" we said. "Could we walk through them, just once?"
The doctor rose, and motioned us to follow him. We walled down several
long corridors; entire families sat waiting in clusters on straw mats.
They looked as if they'd been waiting forever. We entered a room with four
cots, all occupied and stopped at one of them. An old woman sat quietly
by the bedside. The doctor shook the patient's foot gently, smiled, and
said something. The patient, a young girl, emaciated and wheezing, smiled
back. He flipped up the chart hanging on the bedpost, and recited the facts.
"Twenty-five years old, HIVpositive, chronic diarrhea, fever,
mycosis." He pointed to her toenails, which looked as if they had
been badly bumed. "Nails atrophied. Not responding to medication"
Viola. Le SIDA [AIDS].''
We moved on to the next cot, where a young man, equally emaciated, lay
on his side. His eyes were wide open and he stared at us intently. The
doctor flipped his chart open, "This one has TB. We just got his HIV
test back and he is positive, but he doesn't know yet."
"Doesn't know what?'"
"That he has AIDS."
We continued down the ward, in and out of rooms, where people lay, often
wheezing, or lifeless, wrapped in colorful cloth. Some were HIVnegative,
some were positive. They had TB, malaria, meningitis. They had wasting
syndrome, diarrhea, fevers, and vomiting. If they were HIVpositive,
they were told they had AIDS. If not, then they had whatever they had.
"Is it correct to say:" I asked, "that a person has AIDS
if they have any one of these old classical diseases, in the presence of
"Yes, usually," the doctor said.
"Usually? Do you ever see patients in here who have what you would
call AIDS, but test negative for HIV?"
"Negative?" He thinks for a moment and then nods.
"Yes, I see some like this."
"How many would you say?"
"Not very many. A few. A few per month, maybe."
I traveled through central Africa with two other people, Dr. Harvey
Bialy, molecular biologist and scientific editor of the journal
Bio/Technology, who worked as a tropical disease expert in Africa
for many years, and Joan Shenton, a British documentary filmmaker researching
a documentary on AIDS in Africa for Dispatches (Channel Four U.K.)
a program that has consistently challenged orthodox views on AIDS. We went
because we wanted to see it all with our own eyes; to see how the real
picture matched up with the picture we'd been given.
That people die of degenerative diseases at an alarming rate in central
Africa is not in question. The question is how many of those deaths are
really AIDS. We saw many sick, dying, and even dead people during this
trip, but the task of trying to decipher just what they were truly dying
of struck me as impossible. Often, their doctors didn't even know.
In many cases, it seemed not to matter. Death is death, and in Africa,
death is common. But AIDS carries with it the same multiple curses of discrimination,
terror, guilt, and despondency in Africa as it does here. And yet in Africa,
AIDS diagnoses are given liberally, hastily, with little or no testing
to back them up.
Although it was claimed that AIDS originated in Africa, it was not observed
at all there until 1983 - two years after it had erupted in the United
States. By the mid'80s, the "epidemic" was declared. Suddenly,
the media was pouring out reports of a continent on the brink of virtual
extinction. If the epidemiological projections about AIDS in the U.S. and
Europe in the mid'80s were alarming, the ones for Africa were positively
hysterical. There was no question: AIDS was bulldozing Africa, taking
out entire villages men, women, and children, changing the demographics
of central Africa forever.
According to official sources such as the World Health Organization
(WHO), 7 million central Africans are infected with HIV. In Africa, we
were ominously warned, AIDS is spread heterosexuality, and is divided equally
between men and women There was no reason to assume that the U.S. would
not follow suit. If AIDS could explode among heterosexuals in Africa,
why wouldn't it do so here? To assume that it wouldn't follow the identical
pattern of spread in this country as in Africa was, "deep racial bigotry,"
according to A.M. Rosenthal, editorializing in the New York Times.
But, in fact, the figures show that AIDS is a far greater problem in
the U.S. than in Africa. It's true that of all the HIVpositive
people in the world, 69 percent are in Africa and only 16 percent are in
the U.S. However, in terms of actual reported AIDS cases, 44 percent come
from the U.S., whereas only 30 percent come from Africa. Finally, the total
number of AIDS cases in the U.S. is 230,179. The same figure for Africa
is only 151,455. In 1986, it was stated in the medical journal the
Lancet that 60 percent of all children in Uganda were infected with
HIV. The real figure is now recognized as 5 to 7 percent.
Far from being wiped off the snap, all the African countries said to
be hardest hit by AIDS are reporting population growth.
Despite all the hype, all the conferences, all the global AIDS programs,
there is very little in the way of hard data or reliable figures coming
out of Africa. The apocalyptic scenarios have been extrapolated largely
from anecdotal and incomplete evidence. Furthermore, the very definition
of African AIDS is a swell of symptoms that have all been quite common
in Africa for decades if not centuries.
Our picture of AIDS in Africa was in large part fueled by the
idea that AIDS, or HIV at least, originated there. This theory was
based on a few reports that a virus similar to HIV had been found in African
blood samples dating as far back as the 1950s. A virus said to be "closely
related to" HIV was isolated in the African Green Monkey and before
long, the theory evolved than HIV had somehow crossed species, jumping
from monkeys to humans through some unidentified mode of transmission.
This idea was bandied about in leading scientific journals during the mid
to late "80s by AIDS researchers, who also claimed that AIDS
was spread more efficiently in Africa due to extreme sexual promiscuity,
blooddrinking rituals, and children playing with dead monkeys.
It is difficult to prove where HIV "came from," but it seems
no more likely that it came from Africa than anywhere else. As for the
stored blood samples, HIV was found in a Western blood sample dating
back to the 1950s. Several leading scholars and researchers have disputed
the claims that AIDS originated in Africa and is "decimating"
During our almost three weeks in Africa we visited Cote d'Ivoire (Ivory
Coast), Uganda, and Kenya, three of the nations said to be the hardest
hit by AIDS. As if we were hunting some elusive beast, we tried to follow
the footprints, but sometimes they vanished. We got glimpses of insight,
pieces of truth that didn't always fit together. In Uganda, a firstrate
dictatorship, we had to tread lightly, and seek permission and clearance
from various government ministries at every turn. We had to pretend we
weren't really asking the questions we were asking: Is there really an
AIDS epidemic here, What exactly is "AIDS" in Africa? Is it new?
Is it the same thing as AIDS in the U.S. and Europe? If it is the same
disease caused by the same virus, then why does it manifest itself so differently?
Eventually a picture started to come into focus: In the absence of any
reliable diagnostic testing, and with a very broad and unspecific definition
for AIDS, "slim disease," as AIDS is commonly known in Africa,
has become a kind of mopup term for every disease involving diarrhea,
vomiting, fever, or a cough, which are unfortunately also the primary symptoms
of several tropical diseases. None of these symptoms are new to the continent
of Africa, but what is said to be new is the epidemic proportions that
these old symptoms and diseases have taken over the past ten years or so.
AIDS is diagnosed in Africa very injudiciously, and many, many cases
are diagnosed as AIDS despite HIV not being present. Rarely are patients
even tested for HIV, and even more rarely for depletion of CD4 (immune
system) cells. While WHO insists that AIDS in Africa is being grossly underreported,
some doctors and researchers, both African and Western, submit the
opposite that the AIDS figures arc being inflated sometimes beyond
recognition, and that the WHO definition for African AIDS is so nebulous
and broad that it is virtually meaningless.
It appears that infectious, often deadly diseases are indeed rising
to epidemic levels in Africa, but the lines between the old diseases and
the "new" disease, slim, are perhaps hopelessly and indefinitely
blurred. Many believe that the statistics have been inflated because AIDS
generates far more money in the third world from Western organizations
than any other infectious disease. This was clear to us when we were there:
Where there was "AIDS" there was money a brand new clinic,
a new Mercedes parked outside, modern testing facilities, highpaying
jobs, international conferences. A leading African physician practicing
in London, who refused to be named, warned us not to get our hopes up about
this trip. "You have no idea what you have taken on, he said on the
eve of our departure. "You will never get these doctors to tell you
the truth. When they get sent to these AIDS conferences around the world,
the per diem they receive is equal to what they earn in a whole year at
"AIDS is a perception," said Dr. Kassi Manlan, director general
of Health and Social Services in Cote d'lvoire. "The more you look
for it, the more you see it."
Rakai District, Uganda
We were the only car on the road. Joan and I, seated in the back, stared
out the car windows, silenced by the sight. It was as if the whole place
had been shredded a chaos of dust and debris, rotting wood shacks,
garbage, people in rags, children in rags. The poverty in Uganda was crushing,
total, and unrelenting. As we drove deeper and deeper into the Rakai District,
the "AIDS epicenter of the world," all this talk of HIV and Tcells
and safer sex started to seem a little absurd. We got out of the car and
surveyed what looked like a swamp, with a pipe emerging from it. This was,
it turned out, the surrounding villages' water supply. It was also where
the sewage was deposited. People looked listless, malnourished Many of
the children had swollen bellies, thc telltale sign of malnutrition.
"Don't ask them what they eat," advised one doctor we spoke
to, "ask them how often they eat."
The nearest hospital was miles away. There were no cars; the only means
of transportation were donkeys and the occasional bicycle. The Ugandan
government sets and enforces fees for medication, which most people can"t
afford. It became clear to us that most people living in the Rakai district
had no access to health care whatsoever. Malnutrition, filthy water, diseases
left untreated - and the WHO had come in with "AIDS educational programs,"
instructing people how to use condoms?
We went back to the main road and stopped the car. I walked strait into
the first village I saw. At tlhe entrance of the village, a group of people,
mostly men, gathered around to greet me. I had asked a Ugandan radio journalist,
Samuel Mulondo, to come with me to interpret, although some of the villagers
spoke English quite well. I introduced myself and started asking about
"Terriible," said one of them. "I have had two brothers
and one sister die of AIDS already."
"I'm sorry." I said. "What did they die of?"
"I mean what was the cause of death?"
"Ahh, Well, my brother, for instance, he had malaria and we couldn't
afford to get him treatment, so he died."
"So he died of untreated malaria," I offered.
"Why did you say he died of AIDS?"
I asked. He shrugged. "Slim is a formula for everything,"
he said. "When somebody dies, we call it slim."
In Alrica, AIDS Is called slim disease because it is characterized first
and formost by extreme wasting, a condition primarely caused by prolonged
The clinical definition of AIDS in Africa was established at a WHO meeting
in the city of Bangui in 1987, and came to be known as the "Bangui
definition" of AIDS. The three main characteristics are diarrhea,
fever, and chronic coughing, although vomiting and abdominal pain are also
common symptoms. CD4 cell counts are not part of the definition, as testing
is too expensive and therefore entirely unrealistic. Pulmonary tuberculosis
(TB of the lung, the most common form of the disease), in the presence
of HIV, is called AIDS. In fact, TB is listed as the leading cause of AIDS
deaths in Cote d'Ivoire, according for a reported 40 percent.
Visiting scientist Charles E. Gilks, who works at the Kenya Medical
Research Institute in Nairobi, cautioned in a paper in the Britisch
Medical Journal in 1991 that the clinical case definition for AIDS
in Africa is virtually useless, as it fails to distinguish between infections
resulting from HIV, and those such as TB, malaria, and parasitic infections
that are endemic in these parts of Africa, and that, independent of HIV,
themselves lead to severe immune suppression. The results, Gilks warned,
is that "substantial numbers of people who are reported as having
AIDS may in fact not have AIDS."
One of the diseases that is the most difficult to distinguish from African
AIDS is pulmonary tuberculosis, which shares virtually all its symptoms
even if HIV is not present.
"The symptoms are the same by and large," said Dr. Okot Nwang,
a TB specialist working at Old Mulago Hospital in Kampala, Uganda. "Prolonged
fever? The same. Loss of weight, the same. Blood count? A little confusing,
CD4 count, both low. So what's the difference? Maybe diarrhea."
From 1985 to 1989, the number of TB patients at Mulago Hospital practically
doubled. Most of these were cases of pulmonary TB. It is estimated that
there are 4 to 5 million cases of highly infectious TB per year worldwide.
Annually, 3 million people die of the disease. According to a study by
Nwang, pulmonary TB is most common in the age group of 15- to 44- year-olds,
who comprise 70 to 80 percent of all cases. In light of this, it seems
odd that so many doctors make the point that AIDS in Africa is "new"
because it is a disease that is killing young people. TB is also killing
young people. The ratio of male to female cases with TB is also similar
to that of slim, two males to one female. How much of what is called AlDS
in Africa is really TB?
Cote d'lvoire is a rather prosperous country on the west coast of Africa.
Since 1984, there have been 10,600 declared cases of AIDS there. The capital,
Abidjan, a popular tourist resort, is also known as a prostitution and
hard drug center of West Africa. It has been estimated that 50 percent
of Abidjan's prostitutes are HIV-positive, and 1.3 million, or 10 percent,
of the general population are positive. Currently in Cote d'Ivoire, AIDS
is said to be the leading cause of death among men and the second leading
cause among women, the first being maternal mortality.
But the definition of AIDS is problematic and confusing even to African
doctors who work closely with it.
"There is something new, definitely," said Dr. Benoit Soro,
an African doctor who carried out research with Dr. Kevin DeCock from the
U.S. Centers for Disease Control and Prevention (CDCP), urging reappraisal
of the African AIDS case definition "Today young people are dying.
That was not really the case before, not on this scale. People from all
walks of life are dying now- lawyers, doctors. It is not only the poor
people in the villages. I think it is dangerous to compare AIDS with the
old diseases because AIDS is something new."
Dr. Aka Kakou, the infectious disease specialist working at Treichville
Hospital, Abidian, agreed, "None of those diseases are new, it's true,
but they are being expressed in a new way, he said. "Diseases that
used to be treatable, such as TB, malaria, meningitis, are killing people
now. For example, the death rate of meningitis has gone up rather dramatically.
We now lose 60 percent of meningitis patients whereas we used to lose only
45 percent. And cerebral malaria is another disease that used to be very
rare and is now becoming common. I think that HIV is the underlying cause,
of all this. It is exacerbating all these old problems, and rendering them
The problem with that theory however, is that HIV is not a constant
factor. A study published in the British Medical Journal in 1991,
titled "AIDS Surveillance in Africa: A Reappraisal of Case Definitions,"
studied 1,715 patients admitted to three of Abidjan's main hospitals over
a period of three years. All were tested for HIV. Of those, 684 were positive
and 1,031 wore negative. Of the ones that were positive, 35 percent fulfilled
the WHO definition for AIDS. Of the HIVnegatives, 10 percent met the
definition. The point is, many people have what appears to be slim who
do not have HIV and slim is characterized by general failure to respond
to medication or to recover from common sicknesses. Hence there must be
exacerbating factors other than HIV.
"This is hairsplitting," said one doctor working at a major
hospital in Kampala, Uganda. ,"There is something new. I don't care
if it's HIV or something else but it's something that wasn't there before.
I treat people for what symptoms they have when they come to me. That's
all that matters."
Most health officials and doctors we interviewed seemed certain that
AIDS in Africa is a reality and that it is "something new," but
others were less certain. Dr. George Oguna an infectious disease specialist
working in Nairobi, Kenya, when we asked if there is a difference between
TB and AIDS, shook his head. "It's all the same," he said.
"I've not seen an epidemic of AIDS."
While the public seems resentful of the constant repetition that AIDS
is wiping out Africa, the officials generally nod in somber agreement when
the most dire statistics are cited. And to what end? AIDS generates far
more money than any other disease in Africa. In Uganda, for example, WHO
allotted $6 million for a single year, 199293, whereas all other infectious
diseases combined-barring TB and AIDS-received a more $57,000. One of those
diseases, malaria, is still the leading killer of people worldwide,
and several drugresistant strains of malaria have been emerging in
I climb the dark stairwell of Radio Uganda, a huge complex in central
Kampala, and, finally, I find Mulondo's office. Mulondo is one of Uganda's
bestknown journalists, and his specialty is AIDS. He is a closet dissident:
He has doubts about HIV being the real cause of AIDS, and he is exasperated
by the hype surrounding AIDS in Africa. But his broadcasts are strictly
regulated and he has to he very careful not to upset the Ugandan authorities.
A few shards of glass cling to the window frame next to his desk. All
the windows of the building are similarly shattered, or filled with bullet
holes from the civil war.
I have to slip things in very subtly," he said. "My listeners
know how to read between the lines of what I am saying."
Mulondo pointed out that Uganda has been subject to two decades of turmoil,
war, decay, and the unparalleled dictatorship and wreckage of General Idi
Amin, who was ousted from power in the late 1970s. Uganda had a
rather impressive healthcare system through the '60s, but it collapsed
in the '70s and '80s. Many qualified doctors fled the country leaving it
in a state of total disarray. with a terrible shortage of medical supplies.
"People are dying here because they can't afford any basic healthcare,"
he said. The poverty is very bad, people are malnourished. I wouldn't connect
these deaths to sex, not here. I know a lot of people who are promiscuous
and they are not sick.
"Every infection is now called slim, he continued angrily, "and
it's totally neglected in the rural setting. The stigmatization leads to
people not getting medical attention if they are said to have AIDS. Even
in the hospitals. It is considered so hopeless that they don't bother to
Mulondo also does not agree with the statement that middle and
upper-class Africans are succumbing at the same rate as poor people in
Mulondo said he had been trying for months to obtain the real figures
of AIDS in Uganda but that he couldn't get clearance from the AIDS Information
Center, the central bureaucracy that controls the dissemination of statistical
information. He requested statistics on the number of HIV infections, number
of AIDS cases, number of deaths, and comparative death statistics (meaning
how many people died in these regions before AIDS emerged, versus how many
are dying today). He received no statistics. "They say they can't
give you anything unless it's cleared from the top, at government level,"
he said. "And they know I'm skeptical of it all so l can't get it.
They only tell you what they want you to know."
I also tried very hard to obtain these statistics. Finally. I was told
they do not exist. Even in the relatively prosperous Cote d'lvoire, no
actual death statistics are kept.
One hesitates to burst a bubble that may he helping people, however
inadvertently but in this case, as in most situations like this, the money
is being trapped at an administrative level, and hardly trickling down
to the people who need it. It may well be that just as it is argued
in the West figures had to be inflated or else nobody would care,
but in Africa the consequence of this terror is far from innocuous. It
has caused a deep psychological wound that one relief worker, Philippe
Krynen, calls ,"AIDS brain," in which people are so convinced
they will die they actually get sick, so strong is the belief that a deadly
virus has spread like wildfire, and that there is no escaping it.
When Krynen, a French nurse working with AIDS orphans in Kagera, a region
of Tanzania near the Uganda border, first came to the area, he realized
that the first thing he had to do was get a real answer to the question
of how many people were "infected" with HIV, "When I came
here," he said, "people had completely given up. Nobody was interested
in safe sex that's only an option if you think you have a chance.
So we decided to test everybody to find out who was not infected. I figured
that those who were not infected could become leaders and inspire the others.
We tested 150 Tanzanians. We were expecting to find up to 50 percent HIVpositive.
We found 5 percent."
But Krynen reasoned that the sample was not representative of the general
population, that the age groups and levels of education were different.
So he did another round of testing, this time of 842 people the entire
adult population of a village. Of those, 116 were positive, or 13.5 percent.
"We had people who were symptomatically AIDS patients:" Krynen
said. "They were dying of AIDS, but when they were tested and found
out they were negative they suddenly rebounded and are now perfectly healthy."
Krynen even came across an HIVpositive sixyearold, whose
parents are both negative and who has never been to a hospital or received
a transfusion. The only time she ever had an injection was as part of Unicef's
basic vaccine program.
"Everybody talks about development in Africa, but there is no such
thing," Krynen said. "There is only survival. And now survival
is made more difficult because there is no hope for tomorrow. In the villages
where I work, people are totally overwhelmed by the media campaign, which
always repeats the same thing-that you're dead. That everybody is
infected. This is what they call awareness. We are paying a very high price
for this gross exaggeration. The whole community is washed up, despondent,
because of this psychological pressure."
Krynen also did a rough count of how many orphans were in Kagera due
to AIDS. In Africa, a child is considered an orphan if either or both parents
die. Krynen surveyed 160 villages and arrived at a very rough estimate.
"Nobody keeps track of the death toll here," he said. "Maybe
in some hospitals they do, but they'll only keep the figures for two or
three months and then they'll scrap them because they need the paper."
He estimated that there would be some 17,500 AIDS orphans in Kagera. "These
figures were virtually meaningless," he said. "I made them up
myself, but they wound up getting sent off to Kalizizo, and from there
to Dar es Salaam, and then to the National AIDS Control Program. Then,
to my amazement, they were published as official figures in the WHO 1990
book on African AIDS. After that, every six months the figure just kept
jumping up. By now, the figure has more than doubled, based on I don't
know what evidence, since these people have never been here. Today they
say that there are 50,000 AIDS orphans in Kagera."
Mulondo agrees: "This safe sex business is not working. The rate
of promiscuity is increasing because people don't give a damn. They've
been told that 80 percent are infected, that they're going to die, there's
no way out, so people are trying to enjoy themselves. Many people have
said to me, 'What's the point? We're all gone anyway. We're dead.' This
is the result of these exaggerated AIDS scare campaigns."
"If people die of malaria, it is called AIDS," Krynen said.
"If they die of herpes, it is called AIDS. I've even seen people die
in accidents and it's been attributed to AIDS. The AIDS figures out of
Africa are pure lies, pure estimate."
Rakai District, Uganda
Gerald wanted me to meet his family. He grabbed my arm and brought me
over to their hut. It was dark and musty inside. A young woman carrying
a small child emerged. "This is my wife and my daughter," he
said. He told us he was an electrician and his monthly salary was about
1,500 Ugandan shillings, or two American dollars. I asked him, and all
the others standing around, whether they had seen a new epidemic. Were
they clear about what AIDS was? Were they getting any help? Any medical
attention? One man laughed. "They come here in those vans every week.
They give us condoms for AlDS." Gerald clutched my arm. "Madam,"
he said, "we are dying because we have no medication.",
He walked me over to a nearby hut where his sister, a young woman in
her 20s, lay in the dark, alone. She barely stirred when Gerald pulled
the cloth off her to reveal an emaciated body and legs covered with sores.
I started to ask what she had, but then l realized how futile the question
was. Who the hell knows? Certainly no doctor had ever set foot in here.
Whatever she "had," it hardly mattered, because there was no
money to get her any treatment or medicine at all.
Joan and I pulled out what cash we had and gave it to Gerald, asking
that he use it to buy medicine for the girl. We then left the village and
drove up a hill, where there was supposedly a clinic. Sam and our driver
waited outside as Joan and I pushed open the door and walked in.
The place looked thoroughly abandoned dark, dirty, a few cots,
a few cholera posters, a scale. Surely, we asked, this place isn't in service.
We were assured that it was. Suddenly, a woman appeared. "Can I help
you?," she asked. She told us she was in charge of the clinic. When
we asked her if there were any medical supplies she unlocked a padlocked
cabinet which contained a few shelves of various antibiotics.
When Joan returned to Uganda a month later to make her film, she went
back to the village and to the clinic on the hill. That was when she learned
that the reason the medicine cabinet had been locked was that the government
had started to charge money for the medication. She said Gerald had bought
medicine for his sister, and that the sores on her legs had almost cleared
up and she was walking again. *
The report continues in part two here.