From: Blunderov (squooker@mweb.co.za)
Date: Fri Dec 19 2003 - 02:09:59 MST
Jonathan Davis
> Sent: 18 December 2003 1733
> Blunderlov,
>
> Did you see Rian Malan's recent article on this?
>
> Africa isn't dying of Aids
> The headline figures are horrible: almost 30 million Africans have
> HIV/Aids.
> But, says Rian Malan, the figures are computer-generated estimates and
> they
> appear grotesquely exaggerated when set against population statistics
>
>
http://www.spectator.co.uk/article.php3?table=old§ion=current&issue
20
> 03
> -12-13&id=3830
[Blunderov] Shortly after your post, I received my new 'Noseweek' in
which the article you mention is published. It certainly makes for
interesting reading, so much so that I have included it here, in its
entirety, for the edification of the congregation. (The link you offered
does not seem to work properly?)
'The Scramble for Africa' appears to have a new chapter.
Best Regards
<q>
Apocalypse When?
(Noseweek, Issue 52)
Aids is the most political disease ever, writes Rian Malan as he
revisits the statistics and finds some pleasant surprises
As I write, my wife fingers the blade of a carving knife and eyes the
back of my neck, apologies to Chandler and so on. She's sick of this.
It's been going on forever. We met in Los Angeles in the 1980s, at the
very dawn of the Aids era. All the newspapers were full of prophecies
about the heterosexual epidemic that was about to blight our lives. She
wouldn't sleep with me until 1 had HIV clearance.
Later we moved to South Africa, where the anxiety deepened. Every
newspaper we opened provided more details about the Aids bomb that was
about to explode over our heads. Premature deaths would double by 2010.
Life expectancy would fall to 35. Africa's hunger crisis would persist
"for generations" because so many people would be weakened by HIV
infections.
I have seen pictures of people dying of Aids - a terrible sight. I
visualised Jo'burg, with such corpses stacked in the streets, as in the
days of the black plague. It was scary, very scary. That's why I
accepted a contract to assassinate Thabo Mbeki when he started
questioning HIV basics. I speak metaphorically, of course. The weapon
was words, and the contractor was a US magazine that suspected Mbeki had
gone off his rocker. So did I. Everyone knew the facts, and there was
one fact that overwhelmed all others: 250,000 South Africans had died of
Aids in 1999, the year preceding. A quarter-million deaths in a single
year. This was horrible. Apocalyptic, in fact. By far the worst
catastrophe in South Africa's history.
I thought of a novel way to demonstrate Mbeki's folly. My article would
open with a scene in a coffin factory where men worked overtime to
provide caskets for the dead while the president consorted with mad
scientists who believed Aids was a fantasy. I opened the 1999 Yellow
Pages and set to work, only to discover that half of Jo'burg's coffin
factories (okay, two out of four) listed there had gone out of business
since it was printed. More surprising still, the survivors claimed it
was business as usual, no boom anywhere. "How can that be?" I cried,
citing official UN estimates of a quarter-million HIV casualties in the
year preceding. Abe Schwegman of B&A coffins scratched his head. "I
don't know," he said. "You tell me."
By the end of the day I was following Mbeki into Aids dementia, and the
rest was very ugly: ruined dinner parties, broken friendships, ridicule,
fights with US editors. And I never even became a proper dissident. I
was just interrogating the estimates, but the madam's patience wore thin
anyway. Her eyes glazed over. Her fingers thrummed irritably on tables.
After a year she put her foot down. Choose, she said. Aids or me. So I
severed all ties with conspiracy theorists, put my papers in the garage,
and sat out the rest of the war on the sidelines.
Hostilities ended on November 12, 2003, when the government announced a
R12bn, five-year programme to provide antiretroviral drugs through state
hospitals. The war was over. It was safe to come out again. I sat down
at my machine. As I write, the madam is standing behind me, hands on
hips. She does not like what she sees. There will be trouble unless I
keep this brief.
We all know thanks to Twain, that statistics are often the lowest form
of lie, but when it comes to HIV/Aids, we suspend all scepticism. Why?
Aids is the most political disease ever. We have been fighting about it
since the day it was identified. The key battleground is public
perception, and the most deadly weapon is the estimate. When I lived in
LA, HIV incidence was estimated to be doubling every year or so. In
1985, a science journal
that 1.7 million Americans were already infected, with "three to five
million~' soon likely to follow suit. Oprah Winfrey told the nation that
by 1990, "one in five heterosexuals will be dead of Aids."
We now know that these estimates were vastly and indeed deliberately
exaggerated, but they achieved the desired end: Aids was catapulted to
the top of the West's spending agenda, and the estimators turned their
attention elsewhere. India's epidemic was likened to "a volcano waiting
to explode." Africa faced "a tidal wave of death." By 1992 they were
estimating that all humanity was threatened.
Who were they, these estimators? For the most part, they worked in
Geneva for the World Health Organisation (WHO) or UNAIDS, using a
computer simulator called Epimodel. Every year, all over Africa, blood
samples would be taken from a small sample of pregnant women and
screened for signs of HIV infection. The results would be programmed
into Epimodel, which transmuted them into estimates. If so many women
were infected, it followed that a similar proportion of their husbands
and lovers must be infected, too. These hypothetical unfortunates would
proceed to die in dumbfounding numbers, leaving throngs of hypothetical
orphans behind them.
Because Africa is disorganised and in some parts, unknowable, we had
little choice other than to accept this. ("We" always expect the worst
of Africa, anyway.) Reporting on Aids in Africa became a quest for
anecdotes to support Geneva's estimates, and the estimates grew ever
more terrible - 9.6 million cumulative Aids deaths by 1997, rising to 17
million three years later.
Or so we were told. After my bad experience with Joburg's Yellow Pages,
I visited the swamplands west of Lake Victoria where Aids first emerged
and was said to have wrought ghastly havoc. I gathered reams of anecdote
about the epidemic, but statistical corroboration was hard to come by.
According to government census bureaux, death rates in the
worst-affected areas had been in decline since world war two. Aids era
mortality studies yielded some of the lowest "crude" death rates (rate
of deaths from all causes) ever measured. Populations seemed to have
exploded even as the epidemic was peaking.
Ask Aids experts about this, and they say the historic data is too
uncertain to make valid comparisons. But these same experts will tell
you that South Africa is vastly different - "The only country in
sub-Saharan Africa where sufficient deaths are routinely registered to
attempt to produce national estimates of mortality," says British
demographer Ian Timaeus, a titan in his field. According to Timaeus,
upwards of 80% of deaths are registered here, which makes us unique: the
only corner of Africa where it's possible to judge computer-generated
Aids estimates against objective reality.
In the year 2000, even as I was reaching for the Yellow Pages, Timaeus
joined a team of South African researchers bent on eliminating all
doubts about the magnitude of our Aids epidemic. Sponsored by the
Medical Research Council, the team's mission was to validate (for the
first time ever) the output of Aids computer models against real-life
death registration. Towards this end, the Medical Research Council (MRQ
team was granted privileged access to death reports as they streamed
into Home Affairs in Pretoria. The first results became available in
2001, and they ran thus: 339,000 adult deaths in 1998, 375,000 in 1999,
and 410,000 in 2000.
This was grimly consistent with predictions of rising mortality, but the
scale was problematic. Epimodel estimated 250,000 Aids deaths in 1999,
but there were only 375,000 adult deaths in total that year - far too
few to accommodate
UN claims on behalf of the HI virus. In short, Epimodel had failed its
first and only reality cheek. The MRC quietly shelved it in favour of
their own, local model called ASSA 600, which yielded a "more realistic"
death toll from Aids of 143,000 for calendar year 1999.
At this level, Aids deaths were about 40% of the total, which left only
232,000 deaths from non-HIV causes. This, too, was implausibly low, but
the MRC made the problem vanish by stating that deaths from ordinary
disease had declined at the cumulatively massive rate of nearly 3% per
year since 1985. This seemed very odd. How could deaths decrease in the
face of new cholera and malaria epidemics, mounting poverty, the
reportedly widespread emergence of drug-resistant killer microbes and a
health system said to be in 1erminal decline?"
But anyway, these guys were the experts, and their tinkering achieved
the desired end: modelled Aids deaths and real deaths were reconciled,
the books balanced, truth was revealed. The fruit of the MRC's
ground-breaking labour was published in June 2001, and Mbeki's hash
appeared to have been settled, along with mine. To be sure, I carped
about curious adjustments, but fell silent in the face of graphs showing
massive changes in the pattern of death, with more and more people dying
at sexually active ages. "How can you argue with this?" cried my wife,
eyes flashing angrily. I couldn't. I put my Aids papers in the garage
and ate my hat.
A few months later, it started coming up again.
And here I must introduce Rodney Richards, whom I met in cyberspace at
the height of my HIV obsession. Rodney was a dissident from Colorado,
US, but also a scientist with impressive credentials, including a
doctorate in biochemistry and a 10-year stint designing advanced methods
of HIV diagnosis.
Unlike many of his peers, Rodney had the grace to be tormented by doubts
from time to time, and believed these would be settled in South Africa,
the only African country where vast exaggerations could not pass
undetected.
Around October 2001, he contacted me to say that the vaunted ASSA 600
model had been quietly retired and replaced by ASSA 2000, which was
producing estimates even lower than its predecessor: for calendar 1999,
a "mere" 92,000 Aids deaths in total. Rodney interpreted this to mean
that real-life deaths were not exploding at the predicted rate, hence
the need for downward revisions. A year later came another surprise,
this time in the form of a Stats SA study of actual death certificates.
All deaths caused by HIV or any of its euphemisms were counted as Aids
deaths, and there was evidence for only 40,000 such in 1999.
I daren't pursue any of this, not with a wife sworn to leave if I
reverted to old bad habits. Besides, I could barely credit it anyway,
even when Census 2001 produced further alarms. Guided by
computer-generated estimates, most demographers were forecasting that
SA's population growth would slow to around 1.6% per annum as the Aids
epidemic kicked in. Instead, Census 2001 revealed that it was growing at
a healthy 2% a year. I tried to ask Stats SA for an explanation, but
their phones just rang. Ace demographer Professor Laurie Schlemmer told
me that census mortality data is being withheld from publication,
apparently because it is "sensitive."
And then this from Rodney a few months back: "ASSA 2000 has also been
retired." He directed me to the MRC website, where I found a report
noting that modelling was an inexact science, and that "the number of
people dying of Aids has only now started to increase." A new model was
in the works, said the MRC, and it would probably produce estimates
"about 10% lower than the estimates contained in this booklet."
The revision was necessitated, I was told, by the discovery of a tiny
overestimate of HIV prevalence in 2002. But small things have geometric
impact in Aids models, and lowering the 2002 figure causes the whole
epidemic curve behind it to sag. Rodney was reluctant, because such an
exercise is not scientifically valid, but I persuaded him to run the
revised number on his own simulator and see what he came up with for
1999. The answer, very crudely, was an Aids death toll somewhere around
65,000 - a far cry indeed from the 250,000 initially put forth by
UNAIDS.
The madam has just read this, and she is not impressed. "It's obscene,"
she says. `You're treating this as if it's just a computer game. People
are dying out there."
Well, yes. I concede that. People are dying, but that doesn't spare us
from the fact that Africa's Aids pandemic is something of a computer
game. The real question is: is the game doing the dying - or us - any
good? Modellers claim omniscience, but in truth, as they themselves
admit, all estimates are subject to uncertainties and large margins of
error. Much larger than expected, in some cases.
Consider, for instance, all those newspaper stories portraying South
African universities as crucibles of rampant HIV infection. A year or so
back, modellers produced estimates showing that one in four SA
undergraduates were doomed. Prevalence obviously shifted according to
racial composition and region, with KwaZulti-Natal institutions worst
affected and Rand Afrikaans University (still 70% white) coming in at
9.5%.
In the case of RAU, this exercise predicted that one in 10 students
would be infected, but real-life tests on a random sample of 1188 real
students yielded a startlingly different conclusion: on-campus
prevalence was 1.1%, barely a ninth of the modelled figure. "Doubt is
cast on present estimates," said the RAU report, "and further research
is strongly advocated."
Grahamstown district surgeon Stuart Dyer has reached a similar
conclusion about HIV prevalence in South Africa's prisons, where up to
60% of inmates are said to be infected. "Sexually transmitted diseases
are common in the prison where I work," he wrote to The Lancet, "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." Dyer
goes on to express a dim view of statistics that give the impression
that "the whole of South Africa will be depopulated within 24 months,"
and concludes by stating, "HIV infection in SA prisons is currently
2.3%."
This seemed to imply that the Prisons Department had quietly conducted
an HIV survey among inmates, but Dyer declined further comment, so let's
turn to another enigma. SA's medical aid schemes have set up special
programmes to manage an anticipated flood of middle-class HIV cases. The
modellers estimated that around 450,000 people are eligible, but only
22,500 have joined up.
In the Sunday Times, experts attributed this staggering shortfall to
fear of stigmatisation, implying that middle class South Africans are so
prudish they would rather die than consult their GPs about a sexually
transmit ted disease. Do you buy that? 1 don't. Another argument is that
most HIV infected people show no symptoms and are therefore ignorant of
their HIV positive status. I don't buy that either - not when it comes
to the middle class people who belong to medical aid schemes. Middle
class people are tested when applying for jobs, bonds or insurance
policies, and one assumes that middle class sexual athletes have tests
just in case. They see the doctor even for relatively mild illness -
which one in two HIV-positives should be experiencing. People are
encouraged to join the programme immediately they test HIV-positive, so
that their condition can be monitored. Even if you accept, against all
odds, that only 25% are aware of their condition, 112,500 people should
have come forth to join the HIV management programmes. Instead, we're
stuck with 22,500, a four-to-one shortfall - which would tend to support
other indications that the infection rate in this population has been
significantly overestimated.
And so we come to the end of this diatribe. The ashtrays are
overflowing, the room strewn with scientific papers. One says the number
of Aids orphans in Africa might be 30-50% lower than commonly claimed.
Another states that real-life death rates among Africa's teachers are
"typically two to six times lower" than estimated. A third - headlined,
"Cry the beloved paradigm" - argues that sex can't account for HIVs
modelled rampage across parts of Africa unless you assume a probability
of transmission per coital act 300 times higher than anything ever
measured. I could go on, but the madam is spitting mad, and it's more
than my life is worth to continue.
Besides, I'm not sure what it all means. All that is clear at this point
is that over the past four years, SA scientists have proved beyond any
reasonable doubt that Geneva is producing estimates that seem designed
to force a certain outcome. Because Western activists (and scientists,
and drug companies) find Aids more compelling than any other African
problem, they say we should spend upwards of $300 dollars a year keeping
an individual alive with Aids drugs. This is a noble proposition - but
what if that individual's friends and neighbours are dying in much
larger numbers of starvation or politically less interesting, but
equally fatal, diseases that could be cured for a few cents if medicines
were made available, which often aren't?
It is time to have a debate about this. Such a debate couldn't begin
until someone had assessed the accuracy of the estimates emanating from
Geneva. The MRC rose to the occasion. We should be proud of them, and
they of themselves. And we should share their discoveries with African
and Asian states before they are overwhelmed by lobbyists seeking to
commandeer a disproportionate amount of pitifully limited health
resources to fight a condition that is undoubtedly deadly, but whose
rate of occurrence appears to have been hugely overestimated, skewing
political, financial and humanitarian agendas.
</q>
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