Aids was a topic this week on SAfm’s morning talk show, hosted by Tim Modise. Donald G McNeil Jnr responds to some of the issues raised
Dear Tim Modise,
Iam the New York Times reporter who wrote the story about chimpanzees that are the source of the Aids virus being shot for the pot in central Africa that was on the cover of the Mail & Guardian three weeks ago.
I’ve also written parts of a serious, unsensational New York Times series about Aids in Africa, its effects on economies, the huge numbers of orphans it’s created, the way the flood of deaths has changed the culture of funerals, the dilemmas faced by medical researchers working on an impoverished continent, and so on.
I tried to call your show on Monday because I was bothered by what was being said over the air. Now I am writing largely to beg you – not only as a fellow journalist, a fellow sensible soul and as someone who, believe it or not, despite being an American, cares deeply about the future of your terrific country – to beg you not to invite on to your show a lot of American Aids nuts spreading dangerous disinformation.
If I spoke on your show, it would mean nothing – as soon as my accent was heard, many black South Africans would instinctively distrust me because I’m white, many white ones would instinctively dislike me because I’m another arrogant American. My feelings aren’t hurt – as a general rule, those are probably sensible prejudices. But you’re different – because you’re a believable guy, you have a higher moral responsibility to get accurate news about Aids out.
South Africa already has huge amounts of misinformation about Aids flowing around. There’s bad information in drunken shebeen chat, bad information coming from some sangomas, and sometimes even bad information coming out of the Department of Health. If you start putting nuts on your show who say Aids doesn’t exist, who say HIV isn’t the cause of Aids, or AZT is purely evil stuff, or Virodene is a miracle cure, or Aids is germ warfare against blacks dreamed up in a United States army lab, you will be doing the South African people a tremendous disservice.
You wouldn’t invite a sangoma or a rapist on to your show to propagate the destructive myth that sex with a five-year- old virgin cures Aids – you would quite rightly be accused of endorsing child rape.
If this were only bad information about South African politics or US/Africa policy or something like that, I wouldn’t care. The world is full of stupid people saying stupid things; that’s why there are barber shops and bars – they need somewhere to let off steam. To some extent, that’s why there is talk radio. But this is different: misinformation in this case kills people. And it doesn’t just kill grown-up men who ought to know better but are stubborn. It kills babies before they reach three years old; it kills teenage girls who never get a chance to learn how to protect themselves; it kills teenage boys the same way; it kills faithful wives; it kills rape victims; it snatches mothers away from their children. It is well on its way to killing one-quarter of the black population of South Africa.
There is a whole circle of quasi- scientific nuts in the US who make it their business to “debunk myths about Aids”. Some are connected with universities; most aren’t. In doing so, they are spreading many dangerous rumors. They’re convincing people to think the disease doesn’t exist, to believe it can’t affect white people, or it can’t affect black people, to justify not using condoms, to swallow quack cures, and the like.
The US and its news media have been dealing with the Aids epidemic for nearly 20 years now. For the most part, responsible newspapers, television networks and magazines in the US have realised these nuts for what they are and ignore them. They don’t get invited on to talk shows, they don’t get quoted in the paper, and so forth. (The Internet is full of them, of course.)
They are just dying of frustration and desperate to find new forums for their ideas – and South Africa would be the perfect place. It’s got the fastest-growing Aids epidemic in the world, its people are scared, and many of its journalists are relatively gullible because they’ve dealt seriously with the epidemic for less than a year and the history of accurate information about Aids is short.
When I listened to your show on Monday, I was horrified at much of what was said – and then you said you wanted to invite on some American university professor who preaches that Aids doesn’t exist. I didn’t recognise the name, but it doesn’t matter: you can always find someone to preach this stuff.
Look, there’s a tendency to believe that just because someone has a degree from a prestigious American university like Harvard or Berkeley, he’s not a nut. That’s not necessarily the case. In most cases, it’s an indicator that they’re talented in their field, but it’s no guarantee. I graduated from Berkeley in the 1970s, and the place was chock-full of nuts – not on Aids, of course, because the disease wasn’t known then. My brother-in-law is a professor there now; I used to teach journalism at Columbia. I don’t think either of us are cranks, but believe me, we know a few.
Every epidemic has crazy myths around it. There was a time, six centuries ago, that people believed disease was caused by bathing. Two centuries ago, reasonable people believed malaria was caused by swamp gas. They had figured out that people who lived near swamps got it – they just hadn’t figured out the mosquito connection.
What alarmed me about your show was that everyone on it had some grain of truth in what they said – it was just warped by rumours or prejudice into something terribly wrong.
The woman who said that Aids was going to mean a return of white government to this country wasn’t entirely crazy. It won’t, of course. But if one-quarter of the black population of this country is dead in 10 years – and that’s what South Africa is headed for – there are going to be substantial changes in voting patterns. There will still be far more black voters than white ones, enough to keep the African National Congress in power if other things remain the same. (In fact, since UNAids says the infection rates are highest in rural KwaZulu-Natal, as high as 30% in some places, the party hit hardest is going to be you-know-who.) This is something that South Africans have to face up to.
One-quarter of the populations of Zambia and Zimbabwe are already infected. There’s no cure, and the treatment that slows Aids down but doesn’t kill it costs $15 000 a year. With enough pressure on the international drug companies, it will no doubt get cheaper, but it’s not going to come down to $6 a year, which is the per capita health budget in those countries. Those people are going to die.
If you go there, you will see they are already dying. Bodies in the morgues are stacked 10 deep on shelves meant for three. The main cemeteries in Harare and Lusaka are full up, and new ones are being opened. I’ve seen this too with my own eyes – healthy young men lying in coffins, wasted away to skeletons.
Many South Africans still don’t believe in Aids because they haven’t seen enough bodies yet. But they will. It’s going to change this country in ways no one is able to predict.
The woman who said that the disease is due to black promiscuity is partially just an old-fashioned racist nut and partially right. Promiscuity is a problem – Aids is spread by male-female sex. It’s also spread by homosexual sex, by blood transfusions and by sharing bloody needles, but these aren’t important factors in Africa. She took the Aids rate among Africans and turned it into a racist screed about promiscuity. This is not a helpful twist – promiscuity crosses racial lines rather nicely.
There are other factors – many black men and women who don’t see doctors, for whatever reason, have untreated venereal disease – those sores are literally tunnels that let the virus get through the skin of the penis or vagina.
Generally, a condom will protect against these dangers. Condoms are controversial, though it is relatively hard to see why. Seatbelts in cars, lifejackets in boats, even guns in the home are all openly discussed as “life-saving devices” without people getting giggly, squeamish or religious about them.
The woman who said that no one’s ever proved that HIV causes Aids is technically correct, but arrives at a foolish conclusion. Viruses are minuscule, even smaller than bacteria, and you can’t photograph them at work inside the body.
Nobody’s ever “proved” that the cold virus causes colds or the flu virus causes flu, and yet we don’t have any trouble believing in colds and flu. If you inject someone with flu virus, he gets flu; if you inject someone with HIV, he gets Aids.
And it’s also true that Aids tests don’t actually test for HIV. They test for antibodies to it. Most medical tests do that. Viruses are tiny and elusive; antibodies have the helpful habit of seeking out and clumping on to things that activate them, which makes them into large blobs that are easier to detect. The virus exists. People who don’t have it in their blood don’t get Aids. When they get it in their blood, sooner or later, they get Aids. That’s that.
The woman who called to say that AZT shouldn’t be given to pregnant women because Africa will be full of burdensome orphans was just ghoulish. When a white woman dies in a car accident, do you normally go to her house and put her children to death? Aids-infected babies aren’t stillborn. They live for three to five years before they die painfully. I’m a relatively hardened person; it’s a professional hazard. But if you want your heart torn out, go stop by the nursery at the Cotlands Baby Sanctuary and let these perfectly normal-looking toddlers hug your legs or beg to be picked up. Then walk out knowing they will all be dead in a year or two.
The really dangerous person is the one who insisted that Aids doesn’t exist in Africa, that there are just lots of people who suffer from malaria, parasites, fevers, tuberculosis and other diseases that weaken the immune system. Besides being ridiculous, this idea is racist. It presumes that there’s no health department anywhere in Africa clever enough to test people’s blood and figure out what diseases are in it.
Yes, Africans who are dying of Aids are often sick with a lot of other things. That makes it that much sadder – it’s one of the reasons Africans often die faster than Americans who can afford powerful antibiotics, stronger anti-tuberculosis measures, drugs that kill worms and amoebas and other things that live in dirty drinking water. But just because you have other diseases doesn’t mean you don’t have Aids. Aids itself isn’t a disease – it’s a syndrome that weakens you so that other diseases kill you.
One of the reasons doctors realised in the early 1980s that Aids existed in Africa was that wealthy Zaireans were flying to clinics in Belgium and France and then dying from diseases that no one ever saw except in white homosexuals in San Francisco and New York, half a world away: diseases like Kaposi’s sarcoma (the so-called “gay cancer”), pneumocystis carinii pneumonia and cytomegalovirus, which eats away the brain. These are diseases you get in late stages of Aids if you haven’t died of TB or malaria first.
When large numbers of people in Uganda began dying of a mysterious disease called “slim” in the mid-1980s, doctors flew in from Europe and the US with the newly-invented test kits for HIV-1. The number of people with “slim” who were HIV-positive? Virtually 100%. They had Aids.
Let me explain: In the early days of Aids in the US, right after the HIV virus was discovered, there was a clique of quasi- academic nuts who insisted that the virus wasn’t the cause. One was a Berkeley professor, though his degree wasn’t medical. They argued that Aids was caused by the “gay lifestyle” – poppers, amphetamines, all-night dancing and infections picked up from anal sex with multiple partners.
Essentially, they were anti-gay and this was the “God’s revenge on queers” argument in scientific drag. They were frequently on the radio and TV making their case. Then, when it turned out that there were hundreds of thousands of Aids cases in Africa, they had to scramble to make their silly theory fit a new set of facts. This wasn’t easy – I can’t name a single country in Africa where the rural population spends most of its nights in discos, snorts Rush and cocaine and holds wild anal sex orgies. Can you?
Even National Geographic stays away from that one. But this is where the “Aids doesn’t exist, it’s just a mix of malaria, parasites and other central African diseases” theories came from – an attempt to say that the lifestyle of rural Africans is substantially identical to that of white homosexuals in San Francisco. (San Francisco is my home town, by the way. They’re wrong.)
You can lead any lifestyle you want. You can be a Catholic nursing sister jabbed with a hospital needle and spend the rest of your life in church. If that needle had Aids-tainted blood on it, you’re infected.
The woman who said that AZT is a poison is absolutely right. It is a dangerous toxic drug. An overdose can definitely kill you. But it is a poison that seems to prevent the virus from replicating. In combination with other extremely expensive drugs, it may keep it at such low levels that it can’t be detected.
This is exactly how chemotherapy works. Cancer tumours aren’t “bad” -they’re normal cells that just grow way too fast. In a baby, fast-growing cells are normal; it’s called “growth”. In adults, when one lump of cells grows super-fast – a tumour – it gets so big that it chokes off a blood vessel or crushes your brain or your lung. Chemotherapy is giving your body poisonous drugs that kill fast-growing cells better than they kill mature ones. The poisons have to be injected in carefully measured doses so they don’t kill all the cells. Unfortunately, they also kill other fast-growing cells – your hair cells, your new blood cells.
It’s not the cancer that makes a chemotherapy patient’s hair fall out – you can die from lung cancer with a nice thick head of hair. It’s the poisonous chemotherapy. If the chemo works, the patient lives, the cancer is killed, and the hair eventually grows back.
AZT is poisonous, but it works against HIV. All the other anti-Aids drugs – DDI, 3TC, Crixavan, and so forth – are poisonous too. That’s not a reason not to use them: it’s a reason to be careful with doses.
The deputy minister of health who appeared on your programme was more right than most of your callers, thank God. But she was wrong about a couple of things. For example:
l There is not a lot of vagueness about the causes of Aids. Not among legitimate scientists and doctors, anyway. It’s a mutation of a virus that has existed in monkeys and apes, probably for decades, if not centuries. It is not a disease in itself: it attacks the T-cells, which are the triggers for the immune system – white blood cells, antibodies and such. When the immune system fails to function, any disease can overwhelm it: that is the “immune deficiency syndrome”.
The virus jumped from apes and monkeys into humans in the jungles of Central Africa, probably several times. It has been spreading in Central Africa since the 1950s, but very slowly in the first decades because there wasn’t a lot of population mobility and not a lot of doctors.
Somehow, it got out – probably via Kinshasa or another Central African capital. Maybe with the many Haitians working as bureaucrats in Mobutu Sese Seko’s government, maybe with Cuban soldiers in Angola, maybe even with American Peace Corps volunteers – no one knows.
It wasn’t diagnosed until the early 1980s because somehow it got into a very different population: white American homosexuals. Those gay men were, by their own admission, extremely promiscuous. The minute tissue- tearing involved in anal sex increases the chances of sperm-to-blood contact. They were also well-educated, politically active and served very well by doctors.
When they started to die in alarming numbers of a disease no one could identify, they raised an enormous ruckus. Millions of dollars in federal aid became available; dozens of medical detectives went to work. Eventually, the causative virus was isolated, both in France and in the US. Eventually, drugs that suppressed it, even if they didn’t cure it, were found. The disease is now at bay in the US.
l There is not a lot of controversy around the world over whether AZT is cost- effective at preventing transmission. AZT is only one drug in the anti-Aids arsenal. It is the oldest and therefore the cheapest. It costs $80 or less to give a pregnant woman or a rape victim a short course of AZT; it isn’t foolproof, but it’s somewhere between 50%and 80%effective. It costs infinitely more than that to hospitalise a dying child or a dying rape victim for days or months.
When the deputy minister says the department is “taking decisions in a broader context” and has to balance this against other expenditures, she clearly does not understand the meaning of a false economy. If this were polio, no one would be so obtuse about this; it obviously costs far less to give children a few drops of pink vaccine than to buy them crutches and wheelchairs or watch them die slowly.
Please invite on to your show people who really understand Aids. Don’t repeat the mistakes it took the US decades to straighten out.