By Christian Fiala

New African April 1998

Dr Christian Fiala, an Austrian doctor with many years of extensive research on the epidemiological data on HIV/AIDS in Europe, USA, Africa and Thailand, including a fact finding mission to Uganda and Tanzania, exposes the ugly methods used by the World Health Organisation (WHO) in arriving at the alarming figures it publishes about African AIDS. Dr Fiala is also the author of the book on AIDS, Lieben wir gefahrlich? (Do we live Dangerously?: A doctor in Search of the Facts and Background to AIDS), published last year. He is a man with a story to tell.

To understand the present situation with HIV/AIDS in Africa, and the reporting of it, a small excursion into the turbulent history of Uganda (which I am using here as a case study), is necessary.

At the time of independence in 1962, Uganda was hailed as a showpiece of British admnistration, far ahead of Kenya and Tanzania and, for Winston Churchill, at the turn of the century the country was simply "the pearl of Africa".

Uganda's public health system was exemplary for the time. One sign of this was the introduction of an organised blood donor service as early as 1956.

By the beginning of the 1970s, the blood bank for the hospitals in the capital Kampala alone was organising around 14,000 blood donations annually from 350,000 inhabitants. In most cases the blood was not checked for pathogens. The blood bank used sterilised bottles, and the needles were always re-sharpened when necessary. At the time the country did not have a central blood bank, so every hospital organised its own blood transfusions.

Accurate analyses of the way syringes were sterilised in Uganda at the time do not exist. Through anecdotal evidence alone, it is known that, in some cases, hundreds of people were vaccinated with the same needle, a practice which still continues in some parts of the country.

Today the WHO confirms that "at minimum 12 billion injections are performed every year throughout the world" and "at least one-third are not being carried out in a safe manner and may be spreading disease".

The situation is particularly dramatic in Africa, were "more than 80% of disposable single-use syringes are used more than once". A recent investigation in Tanzania found that 12% of the syringes being prepared for use showed traces of the blood of the previous patient.

Then came what are described in Uganda as "the two lost decades". This was the period under alternating dictators between 1966 and 1986, when there was a chain of economic mistakes, mass executions, civil war and war with neighbouring Tanzania. About one million people met a violent death in this period. The country was so fundamentally destroyed that it became one of the poorest in the world. Thus, government expenditure on health at the end of this period was about 9% of what it used to be 20 years earlier.

In 1986, as peace and political stability finally began to return to a totally wrecked country, there was another memorable event. The World Health Organisation published (actually in October 1985 in Bangui, Niger) the above definition of AIDS that was exclusively applicable to developing countries:

Under this definition, Africans are declared to be suffering from AIDS if they have had, for example, diarrhoea for more than one month, 10% weight loss, and cough for one month. An HIV test is expressly not necessary here.

Thus, on the Ugandan health ministry's registration form for people with AIDS in 1991, the possibility of an HIV test is not even mentioned. This means AIDS, the illness that in the words of Professor Luc Montagnier (the French doctor credited with the discovery of HIV) "has no typical symptoms", was being diagnosed in Uganda and other developing countries exclusively on the basis of symptoms.

The required symptoms, however, are not rare in a country like Uganda with 20 years of systematic destruction behind it. So it was not really surprising that Uganda was declared the "epicentre of AIDS".

What is more, as was the case in many African countries, Uganda further redefined the WHO definition. Thus, having tuberculosis in Uganda could quite officially lead to an AIDS diagnosis. As a result, Uganda's AIDS figures rose by leaps and bounds.

Initially, neighbouring Tanzania took the opposite route. There, criteria for an AIDS diagnosis were at first set more narrowly. Two major and two minor symptoms on the WHO definition were necessary. This should actually have led to fewer cases of AIDS in Tanzania than in Uganda. But it didn't. Not all the registered "AIDS cases" in Tanzania actually fulfilled this criteria as evidenced by the following report in August 1990 by the Tanzanian health ministry: "Of the 1,987 new cases registered, only 667 (33.6%) fulfilled the above mentioned criteria. Although 1,320 cases would not strictly qualify to be called AIDS cases, we have taken them as cases assuming that those who reported them just made an omission at the stage of compiling the forms."

The WHO definition of AIDS was simply changed in Tanzania. A "single sign criteria" was added to the definition. This means that a patient is counted as an AIDS case in Tanzania if he/she has one of the symptoms mentioned, and their doctor is convinced that it is AIDS.

Both Uganda and Tanzania justify this procedure on the basis that the WHO definition is too imprecise and that it must be adapted to national circumstances. It is absurd, however, to assume that an infectious disease gives rise to different symptoms this side or that of an arbitrary political border.

In these circumstances, it is hardly surprising that Uganda suffered a sharp increase in "AIDS cases" in the years after 1986. Thus, for example, half of the beds in the internal ward of the Makerere University Clinic in Kampala were occupied by "AIDS patients". That is to say, these patients were running high temperatures, had diarrhoea or were suffering weight loss together with one of the WHO's listed minor symptoms. This led to their being declared as "AIDS patients" without an HIV test.

After the WHO definition had been in use for some years, two other, equally internationally active health organisations, wanted to raise their profiles and attempted to square the circle by diagnosing the "illness without symptoms".

The US Centers for Disease Control (CDC) and the Pan-American Health Organisation (PAHO) arrived independently of each other at the conclusion that the WHO definition of AIDS "may not be adequate for clinical work" because of "the potential inapplicability of that definition".

Both the CDC and PAHO came up with their own new definitions and declared them to be the only ones that made sense. The two new definitions, however, were not created in cooperation with each other or with the WHO, but in competition.

Thus, since then, developing countries have been free to pick and chose which of the three definitions to use in diagnosing AIDS on the basis of clinical symptoms. They are also free to pick and choose from the two different but tighter definitions used by the industrialised countries.

In international statistics, however, all the registrations of people with AIDS are thrown into the same pot, although their numbers are based on different definitions and are thus not in the least bit comparable.

Interestingly, these important details are not known to the public or to many doctors.

Actually one could break off the whole discussion here, and describe all statements about AIDS in Africa as speculation. But it is important to look at how reports about AIDS in Africa are treated in the West.

The WHO "believes" that HIV in Africa is essentially sexually transmitted. This statement is remarkable in a number of respects.

One, after more than 15 years it is clear that there is no AIDS epidemic in the heterosexual population in Europe. Why the opposite should be the case in Africa is ludicrous.

Two, the supposedly "hyper" sexual behaviour of Africans is frequently alluded to by the WHO and the Western medical establishment. But apart from the fact that the first European Christian missionaries in Africa held this belief, there is absolutely no scientific evidence for this view.

On the contrary, Americans lead the world as far as changing sexual partners is concerned. They are followed by France, Australia and Germany. South Africa, like Thailand, is well back in the middle of the sex league as a recent international study published by the condom manufacturer, Durex, shows. But there is of course a long Christian tradition of fantasising about the supposedly licentious sex life of Africans.

If we go back to the competiting definitions of AIDS mentioned earlier, we will find that they have had a devastating impact on AIDS reporting in Uganda and Tanzania, and by extension Africa in general. The number of new AIDS cases in Uganda and Tanzania increased every year until 1991. Since then, the numbers have been dropping.

For the records, we have to emphasise here that all registered AIDS cases worldwide are noted by the WHO in Geneva. As there is certainly an unknown number that are not registered, the WHO multiplies the registered cases in order to reach an estimate of the "actual" figure.

The multiplication factor, however, increases every year. In 1996, the WHO multiplied registered AIDS cases in Africa by 12. In 1997 this had jumped to 17.

In the last one and a half years alone, 116,000 new cases of AIDS in Africa have been registered with the WHO. In the same period, the WHO has raised its statistics for the estimated cases in Africa by a whole 5.5 million, thus multiplying the reported cases by 47.

If one starts from the number of AIDS cases registered on the basis of the above mentioned definitions, then there is only one thing to say: most people in Africa die from symptoms that arise from known and treatable infectious diseases such as malaria, pneumonia or diarrhoea.

The oft-repeated horror scenarios about an epidemic of a new infectious disease in Africa exist exclusively in the heads of the statisticians who, for reasons best known to themselves, use untenable and escalating multiplications to arrive at their alarming conclusions.

On top of this, the statisticians have added together - that is, presented cummulatively - all AIDS cases since the beginning of the 1980s. This form of presentation is extremely unusual in medicine as it produces useless results. The figures automatically rise, even if only a few new cases are still coming in each year.

Thus the monthly publication of the German Medical Board Deutsches Arzteblatt writes, under the headline Cumulative Confusion: "Nobody thinks of adding up the case figures for mumps, tuberculosis or scarlet fever from the day the law on epidemics was passed."

Consequently, the only sense in such a form of presentation is that "huge figures bring in large amounts of public money" into AIDS research and, by extension, into the pockets of the researchers.

It is therefore not surprising that the WHO official reports always announce "an imminent" catastrophe. What is surprising is that almost all journalists dutifully spread the news without raising a single critical question.

The story of AIDS orphans is certainly the most cynical since the discovery of HIV. And it sheds a characteristic light on the nature of how AIDS is reported.

A study carried out by the Orphan Project in New York, estimated the number of children under 14 years old already orphaned by AIDS to total more than one million in seven countries. "Orphans" in Kenya, Rwanda, Uganda and Zambia account for 95% of [the total]," the WHO reported on 25 November 1996.

It continued: "If, for example, we make the conservative guess that already orphaned children represent 10% of the total number of children with HlV-infected mothers in Uganda, this means that more than 3 million children are already feeling the direct impact of the epidemic in [Uganda] alone."

Uganda's current under-15 population is about eight million. If three million of them are feeling the direct impact of AIDS, then there is no doubt that AIDS is now affecting innocent children to an unimaginable extent. Such a finding can only leave one speechless.

This speechlessness is only exceeded by astonishment at another WHO report in May 1991 on the same subject, with the unobtrusive title: "The care and support of children of HIV-infected parents".

On page two of this report, one finds the following note: "The content of this restricted document may not be divulged to persons other than those to whom it has been originally addressed. It may not be further distributed nor reproduced in any manner and should not be referenced in bibliographical matter or cited."

This extraordinary paragraph is followed by some facts about AIDS orphans that one might actually have expected to see in earlier WHO press releases. But no. Because the WHO confesses that, "there is confusion as to what is meant by the term orphan".

It continues: "Projection studies carried out by WHO and studies done elsewhere have used different criteria. UNlCEF defines an orphan as a child whose mother has died, [but] WHO defines an orphan as a child who has lost both parents or only the mother. In the Uganda enumeration study, an orphan is a child who has lost one or both parents (the standard Ugandan definition of an orphan)."

"Lost", however, does not here mean dead, but simply absent, which is why the WHO also adds a far-reaching reservation: "One of the confusing aspects is the extent to which the absence of one parent is the norm in a given society."

What has been said so far should be more than enough to lead one to scrutinise all statements on this subject with the greatest scepticism.

Because of the large number of families with single parents in the world today, even Europe would have a large number of "orphans" if one applied the Ugandan definition.

The WHO itself admitted in the report: "In the Uganda enumeration study, no distinction was made as to the cause of orphanhood, which in some areas included the effects of war."

The world body was referring here to the 20-year rule of terror in Uganda from 1966 to 1986 during which some one million people were killed, and a large number of children orphaned.

People in Africa, and in Uganda in particular, need Western help and support after this long period of suffering. It is neither helpful nor effective if wrong data and absurd definitions are employed to mislead and divert attention from the real problems.

The present situation is leading to huge funds from limited national budgets and from foreign aid diverted into campaigns among others, to promote faithfulness in relationships and the use of condoms.

This is being done in the face of the clear evidence that in Europe the 2,000-year manipulation through Christian teaching on sex has brought about no lasting change in sexual behaviour. And our use of condoms has hardly changed in the last 10 years, despite the numerous campaigns.

The European fixation on a heterosexually transmitted AIDS epidemic in Africa can only be regarded as cynical.

Furthermore, it is incomprehensible why in publications that are not generally accessible, the WHO writes the opposite of what it publishes in its press releases.

One may ask: Why are they doing this?