AIDS in Africa (9)
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Hello colleagues,
I would not claim to be an AIDS expert, but having worked on public
health issues in various sub-Saharan African countries for more than
a decade, I think that I can offer some "common sense" responses to
Carl Webb's disturbing posting on AIDS in Africa.
1. If AIDS is not being spread heterosexually in Africa, why is there
a direct correlation between infection rates and groups known for
having a greater number of casual sexual partners (e.g., commercial
sex workers, bargirls, truck drivers, and soldiers)? We are all aware
of the findings of many studies, from at least 10 countries in sub-
Saharan Africa, in which extremely high HIV prevalence has been docu-
mented among commercial sex workers (60-80%), who as a group have the
highest number of casual sexual encounters. (There are not as many
studies of HIV prevalence among those who are not sexually active,
but the few studies that I have seen show negligible HIV levels among
these groups (e.g., young people aged 5-14)). A division of the US
Census Bureau has been compiling data from various prevalence surveys
conducted in Africa and Asia since 1988 and can provide precise sta-
tistics, if readers are interested.
2. If AIDS is not leading to higher death rates in Africa, then what
accounts for:
(1) the dramatically declining life expectancy rates in many Eastern
and Southern African countries in the 1990s that local censuses and
demographic surveys are documenting (after nearly three decades of
rising life expectancy rates;
(2) the tragic rise of street children and AIDS orphans in these same
countries, who are requiring urgent attention and help from faith-
based organizations and NGOs, who are having trouble coping with all
of the children;
(3) the growing business in coffins in many urban areas, such as Ha-
rare, that has been documented by a journalists from reputable news-
papers such as the New York Times, and
(4) the rising number of our personal friends and colleagues struck
down by a "slim" disease in the prime of life (20s-40s), virtually
all of whom were heterosexual, and who exhibited symptoms that were
not seen in the 1970s? All of these are strong indications that AIDS
is a pandemic which continues to need our concerted effort to address
-- through education, condom distribution, vaccine development, and
the like.
3. If AIDS is not causing an increase in very ill people, then why do
hospital workers in these same countries (some of whom have been
working in the same hospitals for decades) complain bitterly about
their heavier workload in the 1990s and the difficulties they face in
dealing with all of these extremely ill patients? And why do referral
hospitals in places as diverse as Ndola (Zambia), Blantyre (Malawi),
Johannesburg (S. Africa), Harare (Zimbabwe), and many others -- all
of whom use ELISA tests (and other confirmatory HIV tests) for confi-
dential annual prevalence surveys among inpatients -- show marked and
large increases in HIV prevalence over the past decade? Note that
these surveys are performed by extremely experienced clinicians and
as far as I know their accuracy has not been disputed.
I hope that other AFRO-NETS readers will add their own "common sense"
and scientific rebuttals to Carl Webb's piece. This is only a first
start. "AIDS denial" articles such as his require our prompt atten-
tion so that they do not distract and demoralize public health educa-
tors and other professionals who are trying to make inroads in AIDS
prevention and treatment in Africa.
Sincerely,
Paula Tavrow
Deputy Research Director
Quality Assurance Project
7200 Wisconsin Ave., Suite 600
Bethesda, Maryland, USA 20814
Tel: +1-301-941-8452
mailto:ptavrow@urc-chs.com
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