Mbeki, Aids and Statistics unplugged

ONE has got to feel a little sorry for our second President, Thabo Mbeki. Having nursed the country through a transition to democracy, (he was essentially the man who ran the show during the Mandela administration), and having authored the African Renaissance, Mbeki literally ended up on the political scrap-heap, a victim of his own public health policies.

Thabo may have given birth to the African Union and a long-boom which resulted in a massive economic expansion, one not seen since World War 2, but his views on HIV and AIDS, certainly didn’t win him any friends so far as public health policy is concerned. It is one thing to be a dissident scientist, and another to be a President of a country whose administration is responsible for public health policy.

That Mbeki is possibly our most controversial President, can be seen by yet another round of media this week on the subject of the man’s dissident views on HIV.

According to Mbeki “a virus cannot produce a syndrome”.  That HIV exists there can be no doubt. The trouble is that we don’t know everything when it comes to the attached syndrome. Providing citizens with ARVs on demand, and implementing a public health policy that tackles chronic illness, is a sound policy based upon the precautionary principle. Science on the other hand, is dependent upon constantly questioning the data and testing, and retesting the underlying thesis.

This is known as the scientific method.

The duty of the executive isn’t to produce cutting-edge science papers, but rather, to respond to developmental challenges — health challenges which necessitate that action be taken when the majority opinion within science demands it, and particularly when it comes to issues of public health.

Instead of calling for a national science symposium on the subject, Mbeki once again launched into what appears to be his private hobby horse. Having already published on ‘HIV Pathology and DNA testing”, and being the kind of person who questions statistics, I must admit to also being fascinated.

I was thus further moved by a piece by Nathan Geffen published by Groundup, entitled Mbeki is wrong about death statistics, showing graphs in which life expectancy for the average South African reached a low point in 2004. In 2001, according to Geffen, “leading epidemiologists analysed death data in detail. Their report was published by the South African Medical Research Council. They wrote that it was “highly probable that about 40% of the adult South African 1999/00 mortality in the 15-49 age group is due to HIV/AIDS.””

Geffen states that the trough in the life expectancy graph can only be explained by the HIV epidemic and the later improvement upon the ARV programme.

He then goes on to state “(1) People often die of AIDS-related illnesses without being diagnosed with HIV. (2) The doctor filling in a death certificate might, either out of sensibility for the patient’s family due to the stigma of AIDS or because he or she isn’t aware of the patient’s status, indicate the disease that is the immediate rather than underlying cause of death, such as TB or pneumonia.”

Let’s grapple with this for a minute. Firstly, this isn’t science, it is magical thinking.

In one swoop, anyone who dies from TB or pneumonia is presumed to have died of HIV/AIDS. The only way one could arrive at a scientific answer based upon the data, would be to make the disease notifiable — a conclusion resisted by HIV activists. Bear in mind that our country also experienced an epidemic of multidrug resistant TB (MDR and XDR) and the graph could equally show this without any need for an underlying “syndrome”.

Let’s look at another figure: Diarrhoea is one of the leading causes of morbidity and mortality in South African children, accounting for approximately 20% of under-five deaths.

Can this be explained away by the presence of a syndrome?

The persistent concerns raised in the inflation of mother-to-child transmission, infant mortality rates, and the median average for the country compared to other countries in which a 29.9% figure for mothers infected by HIV  was never compared to the average for the entire population, and a prevalence rate amongst the 18-49 age group in the USA (0.6%) to South Africa (17.3%), representing a 11% variance between the developed and developing world, between the rich and the poor, remain.

Driving editorial screaming that the country was the “AIDS capital of the universe”, while removing the very real concerns raised by Mbeki, and related to South Africa’s under-development during apartheid, is what I truly believe, resulted in the entrenchment of a view in his administration, that HIV was some kind of conspiracy by the West.

It would have been far better to simply allow for a national science convention to run its course, and for the leading scientists of the day, to feed into public health policy.






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