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.






Enter the sceptics, and that chestnut, HIV statistics

1. a person inclined to question or doubt accepted opinions.

“Argh. A HIV/Aids sceptic has shown up at our monthly Skeptics in the Pub.”  #JacquesRossouw

For the record. I am not an HIV denialist, I am just sceptical when it comes to HIV statistics and AIDS dogma. In 2001 I was placed under discursive sanctions by the Cape Times after I published an op-ed on HIV Pathology and DNA testing, and no, it wasn’t because of this article, it was because my next article, unpublished, was about the inconvenient statistics part. We ended up with a media-managed “pandemic” and an HIV denialist President. The result is the liberal hellshow of Zuma and Malema

For example, the 2007 UNAIDS report estimated that 5,700,000 South Africans had HIV/AIDS, or just under 12% of South Africa’s population, which stood then at 48 million. Yes it is a large number, but no, it is nowhere near the 40-50% scare stories published by INM at the time the country was debating the issues after years of isolation from mainstream science. Was South Africa really the AIDS capital of the universe?

Lets look at the definition of a pandemic: panˈdɛmɪk adjective (of a disease) prevalent over a whole country or the world.

Read that again: Prevalent over a WHOLE country or the world,  Can one truly say that a 12% prevalence is the whole, i.e. 100%, Do you see the problem? Probably not, because merely questioning statistics of any kind sends off warning bells. Think for yourself, question authority.

Look at the conflicting reports. In 2006 the HIV prevalence rate among pregnant women in South Africa was said to be 29.1%.
According to the 2011 National Antenatal Sentinel HIV Prevalence Survey,  29.5% of pregnant women attending state clinics in 2011 were HIV-positive. Figures like these were often used to drive editorial at the Cape Times, and were compounded and inflated by open speculation. The higher numbers from state clinics were not compared to the lower numbers in private hospitals. The fate of the rich versus the fate of the poor played absolutely no part in the touting of South Africa’s ‘unique problem’.

The same survey for instance estimated that about 5.6-million people living in South Africa were HIV-positive. In other words, 12% of the population. The exact same UNAIDS figure. To put this in a better perspective, compare the 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, nothing like the 50% death rate etched into the minds of the critics of the Mbeki administration resulting in the necessity to “deflect attention” towards the politically expedient view  that AIDS is the result of “poverty, chronic disease,malnutrition and other environmental factors”.

Mbeki based his views on the discredited beliefs of AIDS denialists, especially that of Peter Duesberg.

From a numbers point of view, you have anywhere between a 12 in 100 chance and a 29 in 100 chance of contracting HIV in South Africa, depending upon your demographic group, and which set of data you choose to use. The UNAIDS prevalence rates appear much lower than departmental figures, but this is because they refer to the entire population, not merely a sub-group.

The numbers. though alarming because of this margin of error,  are also sobering.

I recall a screaming match with Judith Soal when my numbers didn’t support her subjective passionate reporting on the plight of hospitalised victims, all of whom were invariably poor pregnant mothers with HIV babies, who had by then been sent home because of ARVs.

Maths may not be my forte but I did pass matric and get a degree in Social Science.

Thankfully, the rate of new infections in the country, represented by the prevalence rate among 15- to 19-year-olds, continues to drop, from 14% in 2010 to 12.7% in 2011. There are some who would say that a bit of journalistic exaggeration  and editorial colour was necessary  in order to drive public policy. But were such shock tactics required?

Weird thing about prevalence is the question of epidemiology. Prevalence rates of an “epidemic” change according to population demographics and geographical region. The language used in these reports are thus often loaded with assumptions based upon the medical model. INM at the turn of the century however, were in the Irish dark ages in which questioning received opinion and common wisdom could get you fired. Besides, HIV scare stories sell newspapers, balance and context tend to tone down such manipulations of public opinion.

Selling newspapers, creating Zackie Achmat and the Treatment Action Campaign (TAC) , and destroying Mbeki was thus more of a priority than having intelligent, balanced debate on all the issues. These shock tactics under O’Reilly were thus bound to create further shockwaves down the line. The reason I say this is because when you force a particular line on the public, even if it be the most scientifically correct viewpoint, without creating a space for dissent and discussion of the consequences of adopting the new opinion, you destroy the basis of free and open inquiry, the very thing upon which science is based.

Take a look at how science operates. There is something called the Scientific Method. A body of techniques for investigating phenomena, acquiring new knowledge, or correcting and integrating previous knowledge. To be termed scientific, a method of inquiry must be based on empirical and measurable evidence subject to specific principles of reasoning. A pandemic in which you not allowed to measure or gather empirical evidence? How is it possible to integrate any information if you are not allowed to question the validity of a hypothesis, if you are not, by nature, a sceptic?

In failing to provide balance and context to its coverage of the South African HIV crisis, INM merely pushed the common wisdom which was in Ireland at the time. This placed the Mbeki administration on the back foot, with tragic consequences as health minister Manto Tshabalala-Msimang, moved by traditionalism, advocated a diet of garlic, olive oil and lemon to cure the disease. The 20 year academic and cultural boycott had hit the ruling party as much as it did the apartheid regime.

This is the kind of article that could have been published in 2001, instead it took ten years for a South African media outlet to print stats like Women have a 1 in 200 chance of contracting HIV via oral sex. The moral grundies who had been warning white South Africans of a special place in hell if the Immorality Act was dismantled had a field day. The Irish-controlled press punted their special brand of moral solipsism, as Catholics waited until 2013 for the Pope to finally see the light on condoms.

South Africa, a country where one is not allowed to question HIV statistics and where you have to blindly accept AIDS dogma as the truth. Is this the same country with a SKA radio telescope programme? No wonder we are so behind in other areas when it comes to science.

Something does not sit well in the above story. It is not that I’m the first person to author a popular article on HIV pathology and DNA testing. A pretty reasonable attempt at relating the science of the day. And it is not because this is one of many such firsts when it comes to my circuitous career in journalism. No, it is the nagging question: Did the conservatives pull a fast one and move from being moral grundies to HIV pundits?

12% of the population holding the remaining 88% of the population to ransom in a world in which the default is AIDS and absolutely everyone is now considered a suspect, has produced a strange result.  We have moved from the solidarity sex of the struggle, to the solidarity of HIV.

The latest news of an American sports personality who garnered massive public support because of his HIV positive status, announcing that he never had HIV to begin with, should serve as a warning.

Equally disturbing, the untimely death of South African television’s first openly HIV positive TV soap star who played the character of Letti Matabane in SABC3’s Isidingo, age 40.

The default position should be on freedom of thought, critical inquiry and consent of the governed, not the views of the church, the party or any one particular idea of morality. A press which provides balance and context is one which ultimately succeeds in maintaining a coherent historical narrative in the long run.

SEE: Mbeki Wrong about Death Statistics