Comments on: “The P.I.G. to Science”: African AIDS and Bethell’s Disgrace http://www.anthonares.net/2005/12/pig-to-science-african-aids-and.html Chronicling and Commenting on Human Progress Thu, 11 Mar 2010 11:51:56 +0000 http://wordpress.org/?v=2.2 By: Anthony Kendall http://www.anthonares.net/2005/12/pig-to-science-african-aids-and.html#comment-170 Anthony Kendall Sat, 11 Feb 2006 16:33:19 +0000 http://www.anthonares.net/2005/12/pig-to-science-african-aids-and.html#comment-170 See <a href="http://scienceblogs.com/aetiology/2006/02/post_3.php" rel="nofollow">this post</a> by Tara Smith in Aetiology that follows a very similar vein as my criticism but is done by an epidemiologist who is a bit better versed in the field than myself. See this post by Tara Smith in Aetiology that follows a very similar vein as my criticism but is done by an epidemiologist who is a bit better versed in the field than myself.

]]> By: Ariane http://www.anthonares.net/2005/12/pig-to-science-african-aids-and.html#comment-71 Ariane Fri, 16 Dec 2005 18:14:00 +0000 http://www.anthonares.net/2005/12/pig-to-science-african-aids-and.html#comment-71 Sorry I'm posting so late, but I just got back from being out of town for 6 days, so I didn't have a chance to read this before. But I am raving mad at Bethell at this point, as not only does he present deceitful evidence for his arguments, but he continues the miseducation of HIV and AIDS in a world. For those of you that don't know me, I am a social worker in a clinic for children with HIV, and I've written research papers on the HIV and AIDS epidemics in the U.S., South Africa, Botswana, and Ghana. I have participated in research projects for Johns Hopkins and the CDC concerning HIV. I also grew up in Cote d'Ivoire, West Africa, where my dad worked in the HIV field for some time. First of all, Bethell's argument that the Elisa test, used in both the U.S. and Africa, is probably showing many false positives, consequently recording too many HIV cases in Africa, shows a lack of understanding of the Elisa test. The Elisa test looks for a match of the HIV antibody created by the body in response ot the existence of the HIV virus. A false positive is possible, since the test does not look specifically for the HIV virus, and some other antibodies may look similar to the HIV antibody. More exact test that search for the virus itself are too expensive and take much longer to produce results, and are therefore not used in testing adults in most cases. However, Bethell does not include in his argument the Western Blot test, which is completed if the Elisa comes back positive. The WEstern Blot looks for a more specific match of the HIV antibody, and will come back negative or indeterminate if the Elisa was a false positive. In addition, people that get tested in Africa are usually already experiencing AIDS symptoms, so a positive Elisa plus opportunistic infections are very good markers for HIV infection. In addition, pregnant women are tested in the U.S. using an Elisa all the time (I work primarily with women who tested positive during pregnancy), and i have never heard of pregancy causing a false positive. Secondly, Bethell argues Africa is using a different diagnosis system for AIDS than the U.S. is false. In the U.S., people who are 13 yrs and older (i.e. adults) can be diagnosed with AIDS either due to a T-Cell (CD4 count) of under 200 OR the occurrence of 2 or more opportunistic infections (infections associated with AIDS, including certain pneumonias and cancers, that infect those with very weak immune systems). Hospitals in Sub-Saharan Africa seem to be using the occurrence of opportunistic infections to diagnose AIDS. CD4 testing it expensive and requires high tech lab facilities, meaning that it is very difficult for poor nations to continually test their patients CD4 counts. However, the method of AIDS diagnosis still meets the CDC qualifications and is parallel to that used in the U.S. Bethell also aruges that South Africa's small size (compared to the U.S.) means they couldnt' be having 20x's the AIDS deaths of the U.S. This shows a basic lack of knowledge about HIV health care in the U.S. Since the mid 1990's, starting with AZT, the U.S. health and pharmaceutical systems have created and utilized various HIV medications that prevent the replication of the HIV virus in people that have HIV. SInce the HIV virus replicates itself through the immune system, these medications not only prevent an increase in viral load of the HIV virus, but also protect the immune system and increase CD4 counts (T-cells) so that those with HIV can fight off infections and the opportunistic infections that lead to AIDS and later death. In fact, these medications have made it possible for people diagnosed with AIDS (due to CD4 counts below 200 - the normal adult's CD4 count is around 700) to increase their CD4 counts back up to the point where they would no longer be diagnosed with AIDS just based on their CD4 count and can fight off infections. However, once diagnosed with AIDS, always diagnosed with AIDS. These medications, when taken by pregnant women, women in labor, and infants in their first 6 weeks of life, reduce the risk of HIV transmission from mother to infant from 20% to under 1% or 2%. Not breastfeeding, using infant formula instead, also reduces the risk of transmission. Health insurance, Medicaid, and the government program ADAP all provide funding for people who can't afford HIV medications to be able to have them. All of these steps forward in HIV treatment and prevention have decreased the incidence of AIDS and AIDS-related deaths in the U.S. drastically. (Infection among gay men has also decreased, and the new population that is being most affected is African-American women, most likely due to issues of poverty, education, and lack of insurance. Thus, it is not a gay disease in the U.S., either.) In sub-saharan Africa, however, the story is quite different. The HIV medications are very expensive, which can cost between $7,000 and $15,000 a year. In countries in which the average daily income is below $1 a day for a quarter to half of the population, this is impossible for not only individuals to afford, but the government to afford, too. The HIV epidemic in Africa caught international attention too late - it was not until about 1998 that the rest of the world started to care about the increasing prevalence of HIV in Sub-Saharan Africa. For example, last year, Botswana (in southern Africa) was experiencing a prevalence of HIV among about 40% of it's pregnant women. Botswana on it's own cannot fund the distribution of medication to all of these women, let alone their children and the men that spread the infection to them. While Botswana estimated the # of people infected in its country to be about 350,000, and the U.S. estimate is about 950,000, most of those that get HIV in Botswana progress to AIDS and eventually die. In the U.S., this is not the case. Consequently, Botswana with only 350,00 infected experienced 33,000 AIDS related deaths in 2003. The U.S. only experienced 14,000. In reality, there were probably many more AIDS related deaths in Botswana that the government doesn't know about, since many people are not tested and their causes deaths would not have been diagnosed. In the U.S., most deaths and causes of deaths are recorded. South Africa, which has a much larger population than Botswana, estimates about 21.5% of it's population to have HIV (that's 1/5 of the population!!!) and as of 2003, estimated that 5.3 million were living with HIV. This is over 5x's the number of Americans even living with HIV, not even taking into account the higher rate of AIDS among the HIV-infected population in South Africa than the U.S. Consequently, it is clearly plausible that South Africa is experiencing such a higher number of AIDS-related deaths. Finally (since this is turning into an essay that no one will read all the way through), I would just like to state that the argument that colonization was better for Africa ignores the fact that colonization is largely responsible for the current instability in most African countries as well as their poverty. Anthony, I have to say, I can't believe you're still reading this book after this chapter. I'll stop now before I provide you with my 82 page research paper i wrote this year comparing the HIV health systems in Sub-Saharan African countries and the U.S.... But all I can say is that there is definitely an AIDS epidemic in Africa, and to ignore it, as many governments did, is only to increase its prevalence and destruction of such a beautiful continent. - Ariane Sorry I’m posting so late, but I just got back from being out of town for 6 days, so I didn’t have a chance to read this before. But I am raving mad at Bethell at this point, as not only does he present deceitful evidence for his arguments, but he continues the miseducation of HIV and AIDS in a world.
For those of you that don’t know me, I am a social worker in a clinic for children with HIV, and I’ve written research papers on the HIV and AIDS epidemics in the U.S., South Africa, Botswana, and Ghana. I have participated in research projects for Johns Hopkins and the CDC concerning HIV. I also grew up in Cote d’Ivoire, West Africa, where my dad worked in the HIV field for some time.
First of all, Bethell’s argument that the Elisa test, used in both the U.S. and Africa, is probably showing many false positives, consequently recording too many HIV cases in Africa, shows a lack of understanding of the Elisa test. The Elisa test looks for a match of the HIV antibody created by the body in response ot the existence of the HIV virus. A false positive is possible, since the test does not look specifically for the HIV virus, and some other antibodies may look similar to the HIV antibody. More exact test that search for the virus itself are too expensive and take much longer to produce results, and are therefore not used in testing adults in most cases. However, Bethell does not include in his argument the Western Blot test, which is completed if the Elisa comes back positive. The WEstern Blot looks for a more specific match of the HIV antibody, and will come back negative or indeterminate if the Elisa was a false positive. In addition, people that get tested in Africa are usually already experiencing AIDS symptoms, so a positive Elisa plus opportunistic infections are very good markers for HIV infection. In addition, pregnant women are tested in the U.S. using an Elisa all the time (I work primarily with women who tested positive during pregnancy), and i have never heard of pregancy causing a false positive.
Secondly, Bethell argues Africa is using a different diagnosis system for AIDS than the U.S. is false. In the U.S., people who are 13 yrs and older (i.e. adults) can be diagnosed with AIDS either due to a T-Cell (CD4 count) of under 200 OR the occurrence of 2 or more opportunistic infections (infections associated with AIDS, including certain pneumonias and cancers, that infect those with very weak immune systems). Hospitals in Sub-Saharan Africa seem to be using the occurrence of opportunistic infections to diagnose AIDS. CD4 testing it expensive and requires high tech lab facilities, meaning that it is very difficult for poor nations to continually test their patients CD4 counts. However, the method of AIDS diagnosis still meets the CDC qualifications and is parallel to that used in the U.S.
Bethell also aruges that South Africa’s small size (compared to the U.S.) means they couldnt’ be having 20x’s the AIDS deaths of the U.S. This shows a basic lack of knowledge about HIV health care in the U.S. Since the mid 1990’s, starting with AZT, the U.S. health and pharmaceutical systems have created and utilized various HIV medications that prevent the replication of the HIV virus in people that have HIV. SInce the HIV virus replicates itself through the immune system, these medications not only prevent an increase in viral load of the HIV virus, but also protect the immune system and increase CD4 counts (T-cells) so that those with HIV can fight off infections and the opportunistic infections that lead to AIDS and later death. In fact, these medications have made it possible for people diagnosed with AIDS (due to CD4 counts below 200 - the normal adult’s CD4 count is around 700) to increase their CD4 counts back up to the point where they would no longer be diagnosed with AIDS just based on their CD4 count and can fight off infections. However, once diagnosed with AIDS, always diagnosed with AIDS. These medications, when taken by pregnant women, women in labor, and infants in their first 6 weeks of life, reduce the risk of HIV transmission from mother to infant from 20% to under 1% or 2%. Not breastfeeding, using infant formula instead, also reduces the risk of transmission. Health insurance, Medicaid, and the government program ADAP all provide funding for people who can’t afford HIV medications to be able to have them. All of these steps forward in HIV treatment and prevention have decreased the incidence of AIDS and AIDS-related deaths in the U.S. drastically. (Infection among gay men has also decreased, and the new population that is being most affected is African-American women, most likely due to issues of poverty, education, and lack of insurance. Thus, it is not a gay disease in the U.S., either.)
In sub-saharan Africa, however, the story is quite different. The HIV medications are very expensive, which can cost between $7,000 and $15,000 a year. In countries in which the average daily income is below $1 a day for a quarter to half of the population, this is impossible for not only individuals to afford, but the government to afford, too. The HIV epidemic in Africa caught international attention too late - it was not until about 1998 that the rest of the world started to care about the increasing prevalence of HIV in Sub-Saharan Africa. For example, last year, Botswana (in southern Africa) was experiencing a prevalence of HIV among about 40% of it’s pregnant women. Botswana on it’s own cannot fund the distribution of medication to all of these women, let alone their children and the men that spread the infection to them. While Botswana estimated the # of people infected in its country to be about 350,000, and the U.S. estimate is about 950,000, most of those that get HIV in Botswana progress to AIDS and eventually die. In the U.S., this is not the case. Consequently, Botswana with only 350,00 infected experienced 33,000 AIDS related deaths in 2003. The U.S. only experienced 14,000. In reality, there were probably many more AIDS related deaths in Botswana that the government doesn’t know about, since many people are not tested and their causes deaths would not have been diagnosed. In the U.S., most deaths and causes of deaths are recorded.
South Africa, which has a much larger population than Botswana, estimates about 21.5% of it’s population to have HIV (that’s 1/5 of the population!!!) and as of 2003, estimated that 5.3 million were living with HIV. This is over 5x’s the number of Americans even living with HIV, not even taking into account the higher rate of AIDS among the HIV-infected population in South Africa than the U.S. Consequently, it is clearly plausible that South Africa is experiencing such a higher number of AIDS-related deaths.
Finally (since this is turning into an essay that no one will read all the way through), I would just like to state that the argument that colonization was better for Africa ignores the fact that colonization is largely responsible for the current instability in most African countries as well as their poverty.

Anthony, I have to say, I can’t believe you’re still reading this book after this chapter.

I’ll stop now before I provide you with my 82 page research paper i wrote this year comparing the HIV health systems in Sub-Saharan African countries and the U.S…. But all I can say is that there is definitely an AIDS epidemic in Africa, and to ignore it, as many governments did, is only to increase its prevalence and destruction of such a beautiful continent.

- Ariane

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