25 years on, questions abound on HIV/AIDS

In those 25 years, we have realised that science is not as powerful as we thought it was (remember Freidrich Nietzsche declaring at the advent of the science age: “God is dead!”) as the world has failed to find a cure for the pandemic. The past quarter of a century has also forced us to rethink our approach to life with psychoanalysts saying there is an increased fear of mortality, people have resorted more to fetishism and voyeurism and sexual intercourse has become “criminalised” in a way. There have been numerous campaigns to halt the spread of HIV/AIDS with governments, non-governmental organisations and individuals seemingly doing all in their power to save humanity. Sometimes the efforts have borne fruit; such as in the recent case of Zimbabwe’s HIV infection rate declining, but mostly there has been little to cheer about in the past 25 years. This has resulted in the proposal and enactment of what sometimes appear to be very extreme measures in trying to deal with the pandemic. Cubans, for instance, have come up with one of the most radical intervention regimes and despite opposition to it by human rights activists, it appears to have yielded the right results. The logic of quarantine, often a non-starter with human rights activists, has had the most encouraging results in dealing with the spread of HIV/AIDS. Cuba’s goal has been to reduce the risk of transmission through case finding, isolation, medical treatment, education and contact tracing ‘ much the same as every other country has attempted to do. Hence, sanatoriums were created in which those with HIV/AIDS were placed and only allowed to leave with a “chaperone”. In 1989, Jorge Perez became director of the Institute of Tropical Medicine and the rules were slightly relaxed and in 1993 the ambulatory care treatment programme was introduced in which carriers were allowed to choose between living in the sanatoriums or outside them. Access to medical care is a right to all with HIV/AIDS and it has been found that those with the virus often tend to prefer to seek the supervised treatment regimes offered by the state as they make life easier for everyone. HIV/AIDS has been treated as a public health emergency and the results have been quite telling despite the trade embargo slapped on the country by the United States. Zimbabweans, too, have come up with their own radical approaches not dissimilar to the Cuban model though authorities have been reluctant to accept them. The Citizens Against AIDS Trust (CAST), led by Retired Brigadier-General David Chiweza, has come up with what it calls the Embryo Effect Strategy. This proposal targets the 10-13 age group with a view to isolating the uninfected so as to create an AIDS-free generation. Those in the age set will undergo mandatory testing yearly and receive a certificate reflecting the outcome of the tests. Failure to comply makes one liable to face the wrath of the law and cannot be employed. Infecting another person knowingly or unknowingly would be punishable, as would failure to produce a valid certificate indicating one’s status. Chiweza defends his radical proposition saying that only pre-emptive attacks on the pandemic will yield results. He says: “Children in the 10 to 13 age set are not yet sexually active hence keeping them free of HIV/Aids will result in an Aids-free generation. “Section 52 of Zimbabwe’s Public Health Act clearly states that the minister can do this to prevent the further transmission of such diseases. Anyone who is not agreeable or obstructs the corrective measure is guilty of an offence and liable to be punished by the courts,” Chiweza illuminates. One of the major shortcomings in the fight against AIDS in Africa has been the disproportionate emphasis on urban areas to the neglect of rural areas. The focus is generally on cities and though there are extension workers doing their utmost best in rural areas but the insinuation from most of the advertisements on television and radio is that HIV/AIDS is an urban problem. This is despite the fact that the majority of Africans reside in rural areas and commercial farms, since colonialism, are melting pots where people from different backgrounds with different value systems mix and co-habitate. And then there have been the more controversial aspects of HIV/AIDS over the past 25 years that some observers have said should have been given more government attention. Some will remember South African President Thabo Mbeki questioning the long-held assumptions the mainstream media and scientists have promoted. He was labelled a “dissident”, “denialist” and “reactionary” for asking the world to relook the HIV equals to AIDS hypothesis and the efficacy of the anti-retroviral (ARV) treatment models we have so readily adopted. Mbeki was ridiculed for questioning the safety of azidothymydine, better known to the world as AZT, as part of antiretroviral treatment (ART). It is documented fact that AZT was originally designed as a cancer treatment drug in the 1950s but production was halted after it was discovered that it was too toxic for human use. How then was it re-introduced as an ARV and how safe are we when AZT is more or less the model on which ARVs are based? A growing number of researchers question that official statistics on HIV/AIDS prevalence in countries like Botswana, South Africa and Lesotho. They cite poor testing regimes and erroneous computer-generated estimates as factors that have hampered the HIV/AIDS fight and have emphasised the need for more “sense” and “less hysteria” in dealing with the issue. Read one critique of the testing regimes: “In Africa, people have a high number of antibodies against infectious diseases or against foreign proteins after receiving blood or dirty injections. Some of these antibodies may lead to a false positive HIV test.” According to the World Health Organisation (WHO)’s Africa definition, “AIDS is diagnosed on the basis of non-specific clinical symptoms and without an HIV test”, and that is why even today, “people with, for example, continuous diarrhoea, weight loss and itching are declared to be suffering from AIDS. But also the typical symptoms for tuberculosis ‘ fever, weight loss and coughing ‘ are officially considered to be AIDS, even without an HIV test”. Adding to the controversies has been Kenyan Nobel Prize winner Wangari Maathai who is on record as saying: “Some say that AIDS came from the monkeys, and I doubt that because we have been living with monkeys (since) time immemorial. Others say it was a curse from God, but I say it cannot be that. “Us black people are dying more than any other people On this planet,” Maathai told a Press conference in Nairobi a day after winning the prize for her work in human rights and reversing deforestation across Africa. “It’s true that there are some people who create agents to wipe out other people. If there were no such people, we could have not have invaded Iraq.” Another sore point has been the growing belief that AIDS has become a class issue in which, according to researcher Julie Torrant, “the rich have access to the available cures as well as the means of prevention, while the poor are denied both and forced to live under intolerable circumstances”. Torrant cites US Republican Senator Dick Gephardt’s attempts to make the anti-Aids fight a purely moralistic issue, while sidelining the economic fundamentals involved as a case in point. She argued that such a stance meant that moral support would be the priority while financial assistance would be relegated. Furthermore, those at the forefront of the lobby might want to tell the world why the AIDS pandemic has not behaved like other disease outbreaks. Scientists have not subjected HIV and AIDS to Koch’s Postulates, which are professionally recognised as the true measure of correlation between virus and symptom. Koch’s Postulates are: The specific organism should be shown to be present in all cases of animals suffering from a specific disease but should not be found in healthy animals. Secondly, the specific micro-organism should be isolated from the diseased animal and grown in pure culture on artificial laboratory media. Thirdly, this freshly isolated micro-organism, when inoculated into a healthy laboratory animal, should cause the same disease seen in the original animal. Lastly, the micro-organism should be re-isolated in pure culture from the experimental infection. None of this has happened or been done when it comes to HIV/AIDS. Goals number six and eight of the Millennium Development Goals respectively seek to arrest the spread of HIV/AIDS and to improve international ties. These two go hand in hand and if the concerns of all are not recognised, if every suggestion is not thoroughly scrutinised, then the world could well face another 25 years of loss in the fight against HIV/AIDS.

June 2006
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