AIDS AND AFRICA:
A CASE OF RACISM VS SCIENCE?
By Rosalind Harrison-Chirimuuta & Richard Chirimuuta
AIDS in Africa and the Caribbean 1997
Western scientists have promoted the hypothesis that the AIDS epidemic
began in Africa, arguing that either AIDS had existed for many years in
an African "lost tribe" or that a retrovirus crossed the species
barrier from monkey to man. The scientific evidence in support of this
hypothesis has included AIDS-like cases from Africa that predated the epidemic
in the West, seroepidemiological evidence for early African infection,
and the isolation of retroviruses from African monkeys considered similar
to the human immunodeficiency virus. Yet when the scientific literature
supporting an African origin is examined it is found to be contradictory,
insubstantial or unsound, whilst the possibility that AIDS was introduced
to Africa from the West has not been seriously investigated. The belief
that the AIDS epidemic originated in Africa has also distorted Western
perceptions of the scale and mode of spread of the epidemic in Africa,
and it would seem that much of the research into AIDS and Africa has been
influenced by racism and not science.
The Acquired Immune Deficiency Syndrome (AIDS) was first recognised
as a clinical entity in 1981 in the United States,(1) and although the
majority of cases even today have been reported from the United States,(2)
the Western scientific community has convinced the world that it is primarily
an African disease and an African problem. To explain how a disease originating
in one continent was yet disseminated to the rest of the world from another,
the scientists have argued that there was a remote central African "lost
tribe" in whom the virus had been present for centuries,(3) or alternatively
who acquired the infection from monkeys 30 or so years ago.(4) Haitians
(but no-one else) working in central Africa then became infected (presumably
heterosexually) and, on returning home, spread the disease to homosexual
American tourists.(5,6,pp.17-20) By this circuitous route the virus reached
the United States and from there spread to the rest of the world.
Because we suspected a racist motivation for the "science"
that was arguing for AIDS from Africa we decided to review the scientific
literature, eventually publishing our work in a book(7). When questioning
the African hypothesis we anticipated a difficult task, as the research
was conducted by reputable scientists and was subjected to peer review
prior to publication. As our study progressed it became increasingly clear
to us that the racist preconceptions of the researchers led them to conclusions
that had no scientific foundation.
The Ideology of Racism
It is perhaps unwise to assume a consensus view of racism where none
may exist, and for our purposes we would consider racism to be the ideology
promoted initially by the Caribbean sugar-planters and slave-merchants
to justify, sustain and defend their activities so important to the enrichment
of Europe during the 17th and 18th centuries. The ideology was adapted
and developed during the period of European colonisation during the 19th
century and in the 20th century, reaching its apogee in the death camps
of Nazi Germany. Unlike the variety of superstitious beliefs Europeans
held of other peoples in previous centuries racism was relatively systematic
and internally consistent, and with time acquired a pseudo-scientific veneer
that glossed over its irrationalities and enabled it to claim intellectual
respectability(8). Although the edifice of racism has begun to crack in
the latter part of this century, racism remains integral to the European
Many leading doctors and scientists of their day made their contributions
to the pseudo-science of racism.(8,9) When humans were placed at the top
of the evolutionary tree, Africans were allocated a separate species between
other humans and apes and there were numerous suggestions that Africans
had sexual intercourse with apes, or were the result of such unions. As
Africans were deemed more akin to animals than humans, they were by definition
incapable of civilised behaviour. They were believed to be sexually unrestrained
and to have larger sexual organs than other races, and were therefore more
prone to sexually transmitted diseases. They were deceitful, treacherous,
lazy, faithless, cruel and bad-tempered. African skulls were studied and
were considered to be smaller than those of Europeans, establishing beyond
doubt that Africans had the lesser intelligence.(8) In one form or another,
explicitly or implicitly, many of these notions have appeared in the scientific
literature about AIDS and Africa.
Racism and "AIDS from Africa"
The first black people diagnosed as suffering from AIDS in any number
were Haitians living in the United States.(10,11) The possibility that
they may have caught the infection from Americans in the United States
or in Haiti was not given serious consideration and Haiti was immediately
accused of being the source of the epidemic.(11) Soon Haitians with AIDS
were being reported from all over the Western world(12,13,14,15) and the
Centers for Disease Control (CDC) in Atlanta, Georgia, included Haitians
as a group at risk for AIDS along with homosexuals, intravenous drug users
and haemophiliacs. It was only in 1985 that CDC, faced with overwhelming
evidence that Haitians per se were no more at risk for AIDS than anyone
else,(16) removed them from the high risk classification, but not before
Haitians en masse were dismissed from their jobs, evicted from their homes,
and even housed in separate prisons. Abandoning Haiti, the researchers
then turned their attention to Africa.
One of the reasons given by scientists for this turn to Africa was the
high incidence of Kaposi's sarcoma (KS) in Africa, although it was clear
from the beginning that the benign clinical course of African KS was very
different from the aggressive, disseminated form of KS in AIDS patients.(17)
A number of AIDS-like cases were reported retrospectively, the most cited
being a Danish surgeon who worked in Zaire and died in 1977.(18) This patient
was given prominence in the best-selling book by Randy Shilt's "And
The Band Played On" where, under "Dramatis Personae" she
is listed as "Danish surgeon in Zaire, first westerner to have died
of AIDS," and is described in the following manner:
"The battle between humans and disease was nowhere more bitterly
fought than here in the fetid equatorial climate, where heat and humidity
fuel the generation of new life forms... Here, on the frontiers of the
world's harshest realities, Grethe Rask tended the sick(19)."
Jonathan Mann, former director of the AIDS program for the World Health
Organisation (WHO) and medical text books are now citing the case as evidence
that AIDS originated in central Africa.(20,21) It was claimed that she
acquired the infection from her patients, at least one of whom had KS,
but there was no firm evidence that she died of AIDS, and other diagnostic
possibilities were not considered. In 1988, five years after the case was
published, we learned that her serum had been tested and found human immunodeficiency
virus (HIV) enzyme linked immunosorbent assay (ELISA) negative,(22) but
the author of the original paper has not published this information in
the scientific literature.
Although such AIDS-like cases are presented as evidence that the human
immunodeficiency virus existed in Africa prior to the American epidemic,
only African cases are considered and the many instances of AIDS-like cases
documented in Europe and America are conveniently ignored.(23) Indeed,
on the opposite page to the report of the Danish surgeon in the same issue
of the Lancet was an account of an AIDS-like illness in a young German
homosexual,(24) but whilst non-AIDS in a Danish surgeon heads the citation
index proving an African origin, the German case has been completely ignored.
The next source of support for the African hypothesis came from the
seroepidemiological studies undertaken in Africa or on African serum stored
in the West. This research, more than any other, has been at the foundation
of all the fantastic stories of millions dying in Africa. Using an enzyme
linked immunosorbent assay seropositive figures of 25% of patients attending
a clinic in rural Zaire in 1984,(25) 50% of the Turkanas in Kenya from
1980-1984,(26) and 66% of children in Uganda in 1972(27) were reported.
As AIDS was rare or unknown in the areas where the serum was collected,
one would expect the authors to have had serious doubts about the reliability
of the tests, but sadly scientific scepticism has never been a feature
of AIDS research in Africa.
One of the most cited studies was undertaken on serum collected in Zaire
in 1959.(28) Using a number of tests in addition to ELISA, only one of
1,213 plasmas was positive, but the identity of the donor, described as
"rural Bantu", was no longer known. As with the sporadic AIDS-like
cases, only seroepidemiology in Africa is considered relevant to the question
of the origin of HIV. A study using the same tests was undertaken on stored
serum taken from "aboriginal" Amazonian Indians in Venezuela
in 1968/69, and 9 of 224 samples were positive on all the tests.(29) The
results were challenged by other researchers as probable false positivity,(30)
but the single positive sample from Zaire continues to be cited as evidence
that the world AIDS epidemic began in Zaire 35 years ago.
In an interview shown on British television Professor Hunsmann, head
of virology and immunology section and professor of medicine at the (West)
German Centre of Primate Research at Gottingen, discussed the problems
"We had conducted quite extensive experiments in respect to the
epidemiology... of the first human retro-virus... HTLV [Human T-Lymphotropic
Virus]-I... For this reason we had several thousand serum samples frozen
and saved in our refrigerated stock. When the news came that there was
another, and new human retrovirus discovered, the AIDS virus... we could
immediately search among our stock and probe for an earlier presence of
this virus in Africa... These tests quickly and clearly gave results, namely,
that the first "positive" probes which we could find among our
more than 7,000 serum samples are dated only after the beginning of the
'eighties, from the years 1982-83; and that among samples from before that
date -- and we had quite a lot of that earlier time in our stock- not a
single one proved positive. We have concluded from all this that most other
researchers had probably fallen victim to the technical difficulties connected
with the conservation and analysis of older serum samples. And the American
authors who originally had produced those high percentage data had to correct
them -- but certainly, once some wrong information like that has been put
into circulation it continues to go on. This has lead to quite a lot of
friction between some African states and the United States."(31)
Later in the same interview when asked why AIDS is not considered to
have originated in the United States, Professor Hunsmann made the following
"Testing of the kind being done in Africa and to that volume has
never been done by anyone in America. Nobody has looked at the stocked
blood serum in the USA and there certainly is much more there than in Africa.
Nor has anyone asked what happened to the general population. Only one
single group, the homosexual community in San Francisco, has been analysed
and the results showed a high percentage of HIV positivity already by the
mid 1970's. But no other samples have been tested to the extent done in
Africa. I think this should be clearly said."(31)
Why, then, if this research is valid (and there have not been any serious
criticisms) have other AIDS researchers persisted in arguing that the African
AIDS epidemic preceded the epidemic elsewhere in the world? And if the
tests are unreliable, why are the predictions that millions of Africans
will soon die from AIDS still presented without comment? How, indeed, is
it possible that a virus could spread so much more rapidly by heterosexual
contact in Africa than anywhere else in the world? It is here as in so
many other aspects of AIDS research, that racist beliefs about the sexual
propensities and promiscuity of Africans conflict with scientific evidence,
and in such a confrontation belief is almost invariably the victor.
Researchers had originally proposed that AIDS was an "old disease
of Africa" that had reached the West via recent intercontinental travel,(3)
a rather curious notion given the enforced intercontinental travel of up
to 100 million Africans in previous centuries(32). As this hypothesis become
increasingly untenable attention was diverted to the possibility of a monkey
origin of the virus. Such ideas cohabit easily with racist notions that
Africans are evolutionary closer to sub-human primates. Dr. Robert Gallo
and his co-workers were among the pioneers of this line of research, both
for HTLV-I and HTLV-III (later renamed HIV).(5,33,34) Two of Gallo's colleagues,
Kanki and Essex, reported the isolation of a virus similar to HTLV-III
in macaque monkeys who were suffering from an AIDS-like illness, and labelled
it simian T-lymphotropic virus type III (STLV-III) of macaques.(35) For
those who were arguing an African origin of the AIDS virus, an Asian monkey
like the macaque was not a suitable source, but less than six months later
the same researchers reported finding the virus in "wild-caught"
African green monkeys from Kenya and Ethiopia.(36) This research, like
most other research on AIDS in Africa, was motivated only by a desire to
prove an African origin of the disease, and was greeted with enthusiasm
by the Western scientific community. Discussion quickly moved on to the
question of how the virus crossed the species barrier, and two AIDS "experts"
from St Mary's Hospital in London even offered this explanation:
"Monkeys are often hunted for food in Africa. It may be that a
hunting accident of some sort, or an accident in preparation for cooking,
brought people in contact with infected blood. Once caught, monkeys are
often kept in huts for some time before they are eaten. Dead monkeys are
sometimes used as toys by African children."(37)
Are we seriously to believe that African parents are so desperate for
toys for their children that they give them putrefying carcasses of dead
animals? More fantastic suggestions were published in The Lancet:
"Sir: The isolation from monkeys of retroviruses closely related
to HIV strongly suggests a simian origin for this virus... Several unlikely
hypotheses have been put forward... In his book on the sexual life of people
of the Great Lakes area of Africa Kashamura writes: "pour stimuler
intense, on leur inocule dans les cuisses, la region du pubis et le dos
du sang preleve sur un singe, pour un homme, sur une guenon, pour ne femme"
(to stimulate a man or a woman and induce them to intense sexual activity,
monkey blood [for a man] or she-monkey blood [for a woman] was directly
inoculated in the pubic area and also the thighs and back). These magic
practices would therefore constitute an efficient experimental transmission
model and could be responsible for the emergence of AIDS in man."(38)
This came in for particular derision at the conference on AIDS in Africa
held in Naples in October 1987:
"When queried regarding the plausibility of a premise put forth
in a letter to The Lancet suggesting that a bizarre tribal ritual of injecting
monkey blood into the pubic region of young African men and women to stimulate
intense sexual activity could be responsible for the emergence of AIDS
in man, researchers from Zaire, Congo and Belgium were unanimous in declaring
it to be preposterous..."(39)
It is hardly surprising that western AIDS researchers have become persona
non grata in many African countries.
Most Africans, in fact, have little contact with monkeys,(40) and amongst
those who regularly hunt monkeys, for example the pygmies of the equatorial
rain forests, AIDS is notable for its absence.(41) On the other hand, in
recent years there has been a marked increase in contact between man and
monkeys not in Africa but in the West. In the 1920's the transplantation
of monkey testes to humans was widely practiced, and many thousands of
men in Europe, America and Australia received the benefit of this operation
that promised to restore their youth and vigour.(42) Monkeys have been
used widely for scientific research, and with the discovery that their
kidneys provide excellent tissue culture material for virus isolation,
propagation and vaccine production, hundreds of thousands have been caught
and transported from their native haunts.(43) If there is any truth in
the hypothesis that HIV originated in monkeys (and African monkeys are
not the only candidates) it would seem more appropriate to investigate
modern medical research than speculate about the customs and behaviour
Although the African green monkey hypothesis was widely accepted, it
came under increasing scientific challenge. Attempts to repeat the Essex
and Kanki experiments on other wild African green monkeys were unsuccessful,(44)
and the genetic sequences of the virus isolated from laboratory macaque
monkeys, the virus Essex and Kanki claimed to have isolated from "wild-caught"
green monkeys and another supposedly human virus called HTLV-IV, were found
to be identical.(45) Essex and Kanki were then obliged to admit that their
green monkey virus was a laboratory contaminant.(46) A retrovirus was eventually
isolated from African green monkeys, but it bore little resemblance either
to the macaque virus or the human AIDS viruses, and could not have originated
from African green monkeys in recent times.(47,48) It is difficult to understand
why this virus has been called simian immunodeficiency virus of African
green monkeys (SIVagm) as it does not cause immune deficiency. In all this
confusion of viruses one question surely needs to be asked: What is the
origin of the virus that caused AIDS-like illnesses in laboratory macaque
monkeys? This virus does not occur in wild macaque monkeys, but does have
some similarity with the human AIDS viruses. Had these monkeys been subjected
to experiments with retroviruses, and did the appearance of AIDS-like illnesses
in the monkeys predate the human AIDS epidemic?
It is instructive for anyone who still has illusions in the objectivity
of science or the integrity of some AIDS researchers to read the October
1988 edition of Scientific American. The issue was devoted to AIDS, and
the section titled "The Origins of the AIDS Virus" was written
by Essex and Kanki and was illustrated by a full page colour picture of
an African green monkey. Eight months after admitting that the African
green monkey virus was a laboratory contaminant, Essex and Kanki have the
audacity to state:
"Why SIV is endemic in these wild African monkeys but seems to
do them no harm, and is also found in the captive Asian macaques, where
it causes disease, was (and still is) an enigma..."(49)
Does this re-presentation of discredited data signal the abandonment
of any pretence of scientific integrity in order to promote conscious and
Other attempts to implicate Africa in the AIDS epidemic also came to
grief. Dr. Anthony Pinching and his team from St Mary's Hospital, London,
claimed that a particular genetic variant, the Gc1f allele, predisposed
the person to infection with HIV, and that this variant was common in central
Africa.(50) The Gc1f allele had, in fact, been found to be common in the
Bi Aka pygmies of the Central African Republic and the Peuhl Fula of Senegal,
ethnically distinct groups in whom AIDS was either rare or notable for
its absence,(41) but it would seem to European minds all Africans are the
same. This research was reported in the media as a major breakthrough in
the search for a cure for AIDS,(41) but a year later, after a number of
other laboratories failed to confirm the findings, Dr Pinching admitted
that their original data was erroneous.(51) At least Dr Pinching, unlike
Dr Bygbjerg and so many other AIDS researchers, had the courtesy to admit
his error publicly and apologise to his fellow scientists for the extra
work he had caused, although his apologies were not extended to the many
Africans whom he had offended.
Although many AIDS researchers now appreciate that they have offended
and angered many black people. they remain ignorant of their unconscious
racism and continue to give offence. The September 1988 edition of Medicine
International was devoted to the subject of AIDS, and as usual there was
an article on AIDS in Africa, but no similar discussion about AIDS in any
other continent. The authors commented on the problems created by earlier
AIDS research in Africa:
"Initial claims that the disease had been present in Africa for
long enough for widespread immunity to have developed in exposed populations
were false; epidemics of AIDS were as new in Africa as elsewhere. Considerable
damage has been done to international research collaboration as a result
of these claims."(52)
But later in the same article:
"The scale of African AIDS epidemic has led to speculation that
heterosexual transmission is more efficient in Africa than elsewhere...
social and cultural factors, such as the African tradition of male sexual
freedom, may also play a part. The circulation of myths such as the only
cure for AIDS being to have sex with a virgin is likely to have a greater
effect on transmission in Africa than in developed countries."(52)
What do the authors of this paper know about African traditions of male
sexual freedom, and does no such 'tradition' exist in the West? And on
what evidence are we to believe that a significant number of African men
are having sex with virgins to cure themselves of AIDS? But then if you
already believe that Africans are more primitive and superstitious no evidence
Other AIDS researchers have recognised that their past activities have
caused problems. The British Medical Bulletin of January 1988, titled "AIDS
and HIV infection: the wider perspective," was edited by three notable
exponents of the African connection, Anthony Pinching, Robin Weiss and
David Miller. They provide a classic example of muddled racist thinking:
"In the case of some early studies in Africa, techniques were used
that had not been sufficiently well validated for African sera, given the
prevalent hypergammaglobulinaemia and a notorious tendency to "stickiness"
and false positive reactions in antiglobulin assays. The observations derived
from these studies have led to some confusion and have also tended to damage
the credibility of foreign scientists working in Africa -- especially among
Who was confused by this bad science? Certainly not Africans, whether
ordinary citizens or "local leaders". The racist themes were
all too familiar, the response was anger and not confusion, and the discrediting
of the science came as no surprise, as it was never believed in the first
place. The AIDS experts continue:
"Additional problems have been created when investigators have
spent a short time collecting sera and basic data in a developing country,
often with little guidance from local investigators, and then published
the data without reference to the original context. This has tended to
produce scientific data that has not been adequately placed in an anthropological
In other words data collection was biased or inadequate, and this led
to a misinterpretation of results. The racism responsible for this is charmingly
described as an inadequate "anthropological perspective!" But
worse is to come:
"Even worse, it has led to denial and resentment, jeopardising
essential and potentially fruitful collaboration between investigators
in the developed and developing world in a study of an issue of mutual
concern. This has been particularly damaging when the pursuit has apparently
been the origin of AIDS and HIV, an essentially academic question, however
interesting. Such investigations have often been taken to imply blame on
the region that appears to be the source. Although they were certainly
never intended to impugn any community in this way, it is not difficult
to see how such perceptions arose."(53)
Recognition that the faulty techniques described at the beginning of
the paragraph provided the "evidence" for an African origin for
HIV is beyond the wit of these clever scientists, who then accuse Africans
of "denial and resentment" when they refuse to accept their findings!
Let us gratefully accept their condolences for the injuries they have inflicted,
and put aside our resentments, so that we can leave ourselves open to more
of the same, to be found later in the Bulletin:
"HIV infection appears to have spread over much of the world during
the decade 1976-1986, mirroring on a large scale the spread of its most
obvious predecessor, syphilis, in Europe in the 1490's. As with early syphilis,
the international spread of AIDS has led to a process of attribution and
denial about the origin of the disease. However, it seems most likely that
HIV spread to the United States from Africa, perhaps via Haiti, in the
mid 1970's and from the United States to many western countries in the
late 1070's and early 1980's."(54)
Others are not so confident, at least when they address Africans at
AIDS and Africa conferences:
"Luc Montaigner, the first scientist to isolate the virus that
causes AIDS, agrees that if an isolated population in Africa existed as
a reservoir for the virus, researchers would have found it by now. The
data suggesting that the virus comes from Africa are weak, Montaigner said.
"Maybe we should look to another part of the world."(55)
Jonathan Mann, then the director of WHO's AIDS programme, also felt
obliged to distance himself from an African origin:
"The World Health Organisation's position is that there is not
yet enough information about the origin of the virus. There are absolutely
no data to support any hypothesis... "The more information that emerges,
the less we know about where this virus came from, how long it has been
in the world, and how it grew to become the problem that it is today,"
he said. The syndrome has too often unveiled thinly disguised prejudices
about race, religion, sex, social class, and nationality, and the Africans
properly resent that Africa has been singled out, Dr Mann said. If San
Francisco was accused of being the original source of HIV with no more
proof than there is that Africa is the source, special interest groups
would be up in arms, he said... Dr Mann said that nothing will keep people
from coming up with "cheap hypotheses" about the origin of AIDS.
"They die a natural death when no subsequent evidence develops to
take then seriously. But journals should have a special page for them labelled
'fuzzy ideas', he said. "The real danger is that future authors might
use such discredited, but published, hypotheses as scientific references
for future articles", he said."(39)
This would seem a classic case of white man speaking with forked tongue,
as there is a qualitative difference between racism and mere "fuzzy
ideas", and whilst the publication of "fuzzy ideas" may
be no more than a reflection on the quality of the journal, racism should
find no place in its pages. The director of the WHO's AIDS program and
his associates were in a position to request that the medical and scientific
journals adopt and implement anti-racist policies. Instead they were content
to show their bleeding hearts only at conferences attended by Africans.
Although racism can be found in abundance in the medical literature
about AIDS and Africa, Two psychologists, J. Phillipe Rushton and Anthony
F. Bogaert, have drawn together these ideas and have attempted to give
them a pseudo-scientific coherence. According to the British newspaper
the Independent on Sunday, Rushton has received funding from a racist American
trust and was investigated by the Canadian police under the hate propaganda
laws. Rushton and Bogaert's paper, titled "Population differences
in susceptibility to AIDS: an evolutionary analysis", was published
in a leading British journal, social Science and Medicine. The abstract
is as follows:
"Previously we have reported population differences in sexual restraint
such that, higher socio-economic status > lower socio-economic status,
and Mongoloids > Caucasoids > Negroids. This ordering was predicted
from a gene-based evolutionary theory of r/R reproductive strategies in
which a trade-off occurs between gamete production and social behaviours
such as intelligence, law abidingness, and parental care. Here we consider
the implications of these analyses for sexual dysfunction, including susceptibility
to AIDS. We conclude that relative to Caucasians, populations of Asian
ancestry are inclined to a greater frequency of inhibitory disorders such
as low sexual excitement and premature ejaculation and to a lower frequency
of sexually transmitted diseases including AIDS, while populations of African
ancestry are inclined to a greater frequency of uninhibited disorders such
as rape and unintended pregnancy and to more sexually transmitted diseases
It is not possible to discuss this article in detail, but the only difference
in substance from the pseudo-scientific racism of previous centuries is
the different ranking order of the races. Mongoloids are now superior to
Caucasoids, although Negroids, of course, remain at the bottom. Meaningless
algebraic presentations such as r/K only give a modern veneer to very old
ideas. We are told, for example, that the average cranial capacity of Mongoloids
is 1,448 cm3 v 1,334 cm3 for Negroids whilst genitalia and secondary sex
characteristics of Mongoloids are, of course, small and that of Negroids
large, and for such reasons AIDS is rampaging through Africa. It is difficult
to believe that such an article would be published anywhere but in a right-wing
fringe magazine, but after a decade of AIDS pseudo-science anything seems
The AIDS establishment has typically responded to the charge of racism
with the counter-accusation that such criticism deny an African AIDS epidemic,
giving African governments an excuse not to take measures to contain the
epidemic. In fact we do not deny the existence of an AIDS epidemic in Africa
and elsewhere in the world, but believe the scale of the epidemic is open
to question. Whilst doctors from the West claim there are tens of thousands
of Africans dying from AIDS, and that millions are already infected with
HIV, the experience of African doctors and ordinary people is very different.
One Zimbabwean woman who in 1988 had not seen or heard of anyone with AIDS
said that it was like being asked to believe in the Holy Ghost.(57) A Ghanaian
physician, Dr. Konotey-Ahulu described the AIDS epidemic in the following
"...The African does not speak of Africa as if it was 'a little
country somewhere in Timbuktu'. Africa is a massive continent with 600
million people in 2,300 tribes distributed in 53 different, sometimes very
different, countries. For example, the difference between Ghana and next-door
Ivory Coast vis a vis the sex trade is the difference between Ghana's ex-colonial
master Britain and Cote d'Ivoire's France. Scientific and media descriptions
of Africa's 'AIDS elephant', with its 53 body parts, have sometimes been
like those of the proverbial blind men surveying the elephant. Most researchers
concentrate on the tusk and, not surprisingly, come out with 'the AIDS
problem in Africa is very sharp and pointed; the whole continent is like
that'. Even when experts from Nigeria, the large body-part of the elephant,
confirm with seropositivity studies that there is not yet an AIDS problem
in their country, they are shouted down with "Under-reporting! Under-reporting!
The whole beast has a sharp profile." To these safari experts, Tanzania
and Sierra Leone, Uganda and Gabon, Zaire and Ghana, Rwanda and Gambia,
are all the same..."(58)
Dr Konotey-Ahulu toured all the AIDS affected African countries (except
Zaire, where he was refused entry, although US government sponsored AIDS
researchers appear to have no such difficulties) and reported his findings
in the British Medical Journal and the Lancet:
"In February and March of this year  I made a six-week tour
of twenty-six cities and towns in sixteen sub-Saharan countries, including
those most afflicted by AIDS, did ward rounds with doctors and nurses,
met ministers of health, directors of medical services, and research workers
(native and expatriate)...
"If one judges the extent of AIDS in Africa on an arbitrary scale
from grade I (not much of a problem) to grade V (a catastrophe), in my
assessment AIDS is a problem (grade II) in only five, (possibly six, since
I was unable to obtain a visa for Zaire) of the countries where AIDS has
occurred... In no country is the AIDS problem consistently grade III (a
great problem), or ever grade IV (and extremely great problem), and in
none can it be called a catastrophe (grade V). In Kenya, for instance,
contrary to widespread reports I would rate AIDS in 1987 as grade 1...
"Before the days of AIDS in Ghana there was a death a day... on
my ward alone of thirty-four beds... They died from one or another of the
following: cerebrovascular accident from malignant hypertension, hepatoma,
ruptured amoebic abcess, haematemesis, chronic renal failure, sickle-cell
crisis, septicaemia, perforated typhoid gut, hepatic coma, haemoptysis
from tuberculosis, brain tumour, Hodgkin's disease... Today, because of
AIDS, if seems that Africans are not allowed to die from these conditions
any longer. If tens of thousands are dying from AIDS (and Africans do not
cremate their dead) where are the graves?...
"Why do the world's media appear to have conspired with some scientists
to become so gratuitously extravagant with the untruth?"- that was
the question uppermost in the minds of intelligent Africans and Europeans
I met on my tour."(59)
Dr Konotey-Ahulu was particularly critical of Western researchers who,
with no experience of tropical medicine, used seroepidemiology as a substitute
for, rather than an adjunct to clinical epidemiology, and described the
difficulties faced by doctors working in Africa who sought funding from
external research agencies to increase their clinical epidemiological research
Although African governments have repeatedly been accused of under-reporting
and the number of AIDS cases notified to the World Health Organisation
from African countries have never reached the expectations of the Western
AIDS establishment,(53) it is important to appreciate how even these relatively
modest figures are derived. In the West AIDS is diagnosed and hence reported
when a patient develops an opportunistic infection or AIDS dementia.(61)
The diagnosis is confirmed with at least two and often more different types
of tests, e.g. ELISA, Western blot, radioimmunoprecipitation assay. Thus
the great majority of patients with symptoms and signs of HIV infection,
i.e. those with persistent generalised lymphadenopathy or AIDS related
complex (now called symptomatic HIV infection) do not reach the official
statistics until they develop opportunistic infections or dementia. There
is a degree of under-reporting (up to 20 percent in the United States)
but virtually no over-reporting.(62) Because of the expense of laboratory
tests for HIV infection and opportunistic diseases physicians and health
workers in most African states have been encouraged to use the WHO clinical
criteria for AIDS, confirmed with ELISA when available.(63) The WHO clinical
criteria do not distinguish AIDS and symptomatic HIV infection, and in
Africa both are therefore reported as AIDS cases.(64) Nor do they differentiate
AIDS from other clinically similar wasting diseases and a number of studies
have shown that between 26 and 50 percent of patients who fulfil clinical
criteria are seronegative for HIV infection.(65,66,67)
Diagnostic pitfalls include infections particularly tuberculosis, parasitic
infestations, lymphomas and occult carcinomas, and endocrine disorders
such as diabetes mellitis, thyrotoxicosis and Addison's disease.(64,68)
Confirmatory testing with ELISA, if available, also presents difficulties,
given the high rate of false positivity with this test. In this context
it is curious to note that the proportion of African AIDS patients who
have died is much lower than that in the West, where it is consistently
50 to 60 percent.(64,65) It is most unlikely that Africans with AIDS live
longer than their Western counterparts, and far more probable that reported
African cases include patients at an early stage of the disease and patients
with clinically similar but less deadly diseases.
If the criteria used to diagnose AIDS in Africa were used in the West
the number of Western AIDS cases would increase manifold, and therefore
comparisons between the incidence of AIDS in Africa and the West are meaningless.
Such difficulties are usually dismissed on the assumption of enormous under-reporting
of AIDS in Africa, but if this were so, what happens to these patients?
Do they die, or do they somehow fade away unmourned, unburied and unrecorded.
In Africa as in the West AIDS is predominantly afflicting the young, sexually
active section of the population and a change in the pattern of disease
and death in this group would be reflected in official statistics even
if not reported as due to AIDS. This has been demonstrated in Britain where
there has been an increase in the death rate amongst young men, and up
to 500 may have died of AIDS in the last year without being reported as
Yet Western researchers seem incapable of believing that African countries
gather such statistical information although it is often readily available
in the libraries of their own institutions. When comparing the incidence
of AIDS in different countries it is also important to consider the rate
of progression from HIV infection to 'full blown' AIDS. It is probable
this will be more rapid in countries with a high rate of infectious and
parasitic disease, and consequently the proportion of AIDS patients to
the number with HIV infection will be higher. Even if African states were
using the same criteria to diagnose AIDS as in the West, assumptions about
the prevalence of HIV infection based on Western experience would be misleading.
Even if one chooses to ignore the information provided by various African
Ministries of Health some assessment of the scale of the African epidemic
can be made by studying expatriate Africans. Many Africans in Europe and
America are temporary residents, or travel home frequently, and AIDS in
this group should mirror the epidemic in their countries of origin. Whilst
there was much excitement about the incidence of AIDS in expatriate Africans
in Europe in the early 1980's,(69,70,71) the number of Africans diagnosed
in Europe actually declined between 1984 and 1986,(72) perhaps because
reliable tests for AIDS became available, and only in 1987 showed a modest
increase. Africans with AIDS in Europe are no longer reported separately
by the WHO,(73) perhaps because they have ceased to be a significant proportion
of the total European cases. Although there was much talk of the risks
of transmission of HIV-2 by West Africans in Britain, more than 6,500 patients
with West African connections were tested and all were found negative for
this virus.(74,75) It is curious that expatriate Africans in the United
States have never featured in discussions about the supposed African origin
of AIDS, nor have they been reported as suffering from AIDS in any number.
Sound scientific methodology surely dictates that evidence contrary
to a proposed hypothesis should be sought as vigorously as evidence for
the hypothesis. In the case of AIDS from Africa contrary evidence has not
been sought at all, but this singular deficiency in effort is then presented
as a lack of result. If scientists did wish to explore the possibility
that HIV was introduced to Africa from the United States and Europe we
would mention two possible areas for research. The first is the export
of infected American blood products. Discussion in the scientific literature
about Africa and transmission of HIV by blood products inevitably concentrated
on the possible importation of infected plasma to America from Africa (an
unsubstantiated hypothesis that died quickly),(76) or the spread of HIV
in Africa by local blood transfusions.(77) We could find only one reference
to the export of infected American blood to third world countries, in a
WHO working paper where it was said that contaminated plasma pools may
have been sold at discount prices in developing countries since they could
not check the products.(78) Western countries outside the USA are for the
most part self sufficient in whole blood and plasma, and the only significant
group infected from America were haemophiliacs who were given imported
American clotting factors. Poor countries often cannot afford a blood transfusion
service, and wealthy patients with blood loss may be transfused with imported
blood whilst the poor at best receive an immediate transfusion from a relative
or friend. If imported whole blood was responsible for introducing AIDS
into Africa, this would be consistent with the initial appearance of AIDS
in the urban-based elite in countries like Zaire which are particularly
dependant on America. It would also account for the development of AIDS
in expatriate Europeans, such as the French woman who developed AIDS after
a blood transfusion in the Cameroons, as it is unlikely that she was transfused
with locally obtained blood.(79)
A second, and we suspect far more important route by which AIDS may
have been introduced into Africa is sex tourism. AIDS researchers, who
seem unable to contemplate that white men can infect African women, have
presented AIDS in Africa as a disease transmitted by promiscuous men (and
to racist minds all Africans are promiscuous) to prostitutes who then infect
foreign clients.(80) Prostitution in African countries tends to occur at
two levels: with younger and prettier women seeking valuable foreign exchange
who work in the large hotels and night spots which attract foreign tourists
and wealthy Africans, and with older and less attractive women whose clientele
is predominantly poor and local. If African realities agreed with the researchers
suppositions, older African women and their local clientele would be bearing
the brunt of the epidemic, but to the contrary it is the young women frequenting
the tourist centres and foreign military and naval establishments who are
developing AIDS and are transmitting it to their African sexual partners:
husbands, boyfriends and wealthy African clients.(58,81)
When discussing the issue of the origin of AIDS we are frequently asked
by well meaning people "Does it really matter where AIDS came from,
shouldn't we forget about the origin and concentrate on dealing with the
epidemic". Certainly we agree that every effort should be made to
contain the epidemic, in Africa as elsewhere in the world, but AIDS researchers
have opened a Pandora's box of racism and prejudice that cannot be closed
by simply dropping the subject of the origin. Incorrect assumptions about
the source and nature of the African AIDS epidemic will also inevitably
lead to inappropriate programs for containment and control. Africans have
complained that scarce resources from the WHO have been diverted from programs
to control major epidemic diseases that are killing many more people than
AIDS, and insufficient emphasis has been placed on the risks of sex for
money whilst the dangers of low levels of promiscuity have been exaggerated
to such an extent that people have even committed suicide because they
feared they had AIDS.
Although racism in its various manifestations has come under increasing
challenge in recent years it remains a potent influence, and it is naive
to believe that medical science is immune to this particular poison. With
the emergence of a new and deadly sexually transmitted disease it was perhaps
almost inevitable that Black people would be attributed with its origin
and transmission, whatever the evidence. Racism is an irrational system
of beliefs without scientific foundation, and much of the confused, contradictory
and simply nonsensical conclusions reached by the scientists about AIDS
and Africa can be attributed to their attempts to square their research
findings with their racist preconceptions, rather than objective scientific
reality. The determined pursuit of the African origin has been of little
scientific or practical merit, but instead has escalated racism, created
conflict between African and Western countries, diverted resources away
from areas where they are much needed, and has wasted time. Let us hope
we can learn from our mistakes, otherwise we will be doomed to repeat them. *
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Source: Chapter 12 of "AIDS in Africa and the Caribbean" edited by:
Professor George C. Bond, professor of anthropology and director of the Institute of
African Studies, Columbia University, John Krensike, associate professor of
anthropology ar Hofstra University, Ida Susser, professor of anthropology at Hunter
College, City University of New York, Joan Vincent, professor of anthropology at Barnard
College, Columbia University. Published by Westview Press, 1997. ISBN 0-8133-2878-0.