http://bmj.com/cgi/content/full/324/7331/237
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Letters
President Mbeki might have a case on rethinking AIDS
As a prison medical officer in South Africa,
I partly agree with President Mbeki's sceptical view of current statistical
research into HIV infection and AIDS.1
The research data tend to be formulated from actuarial models and short
trials in pregnant women attending antenatal clinics. Pregnancy is
known to cause a raised rate of false positive results on testing
for HIV infection with enzyme linked immunosorbent assay (ELISA).
The results of such research lead to frightening statistics, giving
the impression that the whole of southern Africa will be depopulated
within the next 24 months.
In South Africa's prisons there is a vast overcrowded (often 30 people
per cell) population in which homosexuality is widespread and condom
use practically non-existent. This is the perfect breeding ground
for the rapid spread of HIV.
Sexually transmitted diseases are common in the prison where I work, and all
prisoners who have any such disease are tested for HIV. Prisoners
with any other illnesses that do not resolve rapidly (within one to
two weeks) are also tested for HIV. As a result, a large number of
HIV tests are done every week. This prison, which holds
550 inmates and is always full or overfull, has an HIV
infection rate of 2-4% and has had only two deaths from AIDS in the
seven years I have been working there.
The HIV infection rate for all South Africa's prisons is currently 2.3%. The
rate in the prison population should be higher than that in the
general population, or at least the same. But the figures for
prisons in South Africa are way below those generated by actuarial
models and antenatal data, which purportedly reflect the incidence
of infection in the general population.
A widespread mystical attitude towards HIV/AIDS gives this disease recognition
out of all proportion to its incidence (compare it, for example,
with the number of deaths in southern Africa from malaria,
tuberculosis, malnutrition, road crashes, and murders). The legal
and ethical implications of this attitude ensure that no statistical
research is based on random testing of the general normal healthy
population. Data from this kind of research, were anyone brave
enough to conduct it, would probably show figures more like those
found in the prisons.
Stuart W Dwyer
Postnet Suite #5, Private Bag X1672, Grahamstown, 6140 South Africa swdwyer@eastcape.net
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1. |
Sidley P. Mbeki plays down AIDS and orders a rethink on
spending. BMJ 2001; 323: 650 |
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