Rian Malan’s crime is not just saying the unsayable, but saying it so well. He has picked the one cause which unites almost everyone, from George Bush to Bono, and declared it a con. Africa, says Malan, is not dying of Aids at all. The apocalypse you hear about, the tide of death leaving a continent of pensioners and orphans, is not happening.
At least nowhere near as fast or widely as lobby groups pretend, says Malan, speaking with the authority of a feted South African writer who has spent three years scrutinising statistics, mortality rates and computer projections.
It is a conclusion which has transformed a celebrity into a self-confessed ‘moral leper’ accused of trying to derail worthy causes. Malan has ruined dinner parties, broken friendships, attracted ridicule from experts and fought with his wife. Now he has just upped the stakes with a cover story in Britain’s Spectator magazine, warning that $20-billion could be blown in the next few years in response to exaggerated estimates about the disease’s impact in Africa. ‘It seems to me that Aids fever is nearing the danger level, and that some calming thoughts are called for,’ he writes.
Calm is not often associated with Malan’s readers. Amusement and discomfort are common reactions to his 1991 book My Traitor’s Heart, a confessional of a dope-smoking Afrikaner who loves but fears the blacks about to take over his country. In the acclaim that followed, Malan had interviewers swooning, Mick Jagger asking for screenplays and glossy magazines commissioning features. Afrikaners did not come more hip. He pitched Rolling Stone a piece on how Aids was wiping out South Africa while President Thabo Mbeki, mesmerised by crackpot theories about the disease, did nothing. ‘So I set out to confirm the death toll,’ he wrote. ‘Just that. I thought it would be easy — a call or two, a brief interview. I picked up the phone. It was my first mistake.’
The article, published in 2001, launched Malan’s new career: plague sceptic. His research convinced him that the scientific establishment had systematically inflated the number of dead and dying. In the Spectator he reiterated the thesis: ‘Aids is the most political disease ever and the key battleground, public perception, is fought with a deadly weapon, the estimate. Most of the figures you see come from the World Health Organisation or UNAids. They use a computer simulator called Epimodel which extrapolates from a small sample of pregnant women screened for HIV, the virus which causes Aids. The estimates grew ever more terrible: 9,6-million cumulative Aids deaths by 1997, rising to 17-million three years later.’
But when Malan sought corroboration he found populations exploding, not shrinking. Historical data in Africa was too unreliable for such comparisons, the experts explained, though there was one exception, South Africa, which registered most deaths.
So the former crime reporter tracked statistics on his homeland and found Epimodel estimates of 250 000 deaths for 1999 were reduced by a later, more sophisticated computer model to 92 000 deaths. The Medical Research Council said it was working on yet another model which would ‘probably’ produce yet lower estimates.
Malan delved. Modelling exercises put HIV prevalence at 12% for South Africa’s bankers, but when 29 000 staff were tested the rate was three per cent. Only 1,1% of undergraduates at Rand Afrikaans University tested positive — a ninth of what models predicted. Coffin makers in Johannesburg grumbled that business was slow. The ‘estimators’, Malan concluded, failed reality tests.
‘Please don’t get me wrong,’ he wrote. ‘I believe Aids is a real problem. Governments and sober medical professionals should be heeded when they express deep concerns about it. But there are breeds of Aids activist and Aids journalist who sound hysterical to me. On Aids Day they came forth like loonies drawn by a full moon.’
The implications are huge. What if Africa does not have 30-million people with HIV? If South Africa is not losing more than 600 people a day? Would billions of dollars be better spent fighting malaria, diabetes, measles and a host of other diseases? Is Malan right?
‘There are nuggets of truth, elements of sense and serious questions posed — but overall a complete lack of understanding of data,’ said Professor Alan Whiteside, a development economist at the University of Natal and an authority on HIV/Aids in South Africa. Statistics were less accurate than desired and Aids-related mortality rates had been overstated, said Whiteside, but Malan ignored more recent data which showed HIV rates soaring above 30%, something once believed impossible. Infected Africans were living longer than expected but without anti-retroviral drug therapy many would soon succumb.
Professor Ed Rybicki, a University of Cape Town biologist, used Malan’s methodology and came up with different numbers. A glaring error, said Rybicki, was that at any one time only 10-15% of those with HIV are sick with Aids — partly explaining the low numbers seeking treatment. ‘I think Malan is extremely well-meaning but has latched onto a conspiracy theory,’ he said.
Malan (49) has become a darling of the Aids dissidents — scientists and crypto-scientists who dispute the link with HIV, detecting a plot by pharmaceutical multinationals and the medical establishment to hype the disease for profit. Mbeki was a devotee.
Critics say Malan has steered clear of joining the crackpots, just, but fret that he fuels dissident agitprop. ‘There is a ready market of people who would like to believe this epidemic is not as huge a problem as they’ve been told,’ said Dr Ian Timaeus, of the London School of Hygiene and Tropical Medicine. Timaeus, of the Medical Research Council team whose findings Malan challenged, accuses him of using celebrity doom-mongering to taint serious number crunchers. ‘Just because Oprah Winfrey said something silly about Aids in 1993 doesn’t mean last year’s US statistics were unreliable.’
When motive is raised the debate turns nasty. Quoting others, Malan suggests scientists and lobby groups distort statistics when chasing funding and influence. Privately, some return the compliment, accusing Malan of using Aids to revamp a career largely stalled since My Traitor’s Heart.
Malan confesses that his ‘leprous obsession’ has infuriated friends and his own wife. Some points hit home. Behind their technical language, scientists and lobby groups are fiercely competitive for reputations to be made from Aids. Some journalists enjoy hyping the worst scenarios.
Warren Parker, director of Johannesburg’s Centre for Aids Development, Research and Evaluation, said Malan is right to question statistics. ‘We have relied on models and projections for far too long and there is an urgent need for a new generation of research that doesn’t play to the tedious refrain that nothing is working and the only solution is more money and disparate — or desperate — interventions.’
Anecdotal evidence of the tolls taken by Aids on Africa abounds. From the back pages of the Sowetan daily paper gaze passport-sized photos of the deceased, mostly young adults. A Namibian trucking company wants to import Ukranian drivers because locals die so fast. A Swazi village goes hungry because farmers are too sick to harvest.
As director of perinatal HIV research at Johannesburg’s Wits University, Dr James McIntyre sees babies and mothers die at a rate suggesting Aids is South Africa’s main cause of death, notching up more than 600 per day. He said: ‘It’s always useful to have critical debate but we shouldn’t get tied up in pointless arguments.’ – Guardian Unlimited Â