Transcript UK Channel 4 Dispatches Documentary
Meditel, London 1993
drums, played nightly after the news in Uganda sent a chill of
fear through the people. For a period these funeral drums were
used to tell them what would happen if they made love to someone
new without using protection. HIV would get them - AIDS would
of AIDS in Africa over the past eight years has been one of unremitting
horror. The World Health Organisation describes subsaharan Africa
as having the highest rates of HIV infection in the world - an estimated
1 in 40 adults - and predicts that by the end of the century there
will be half a million deaths a year.
like these by Professor Roy Anderson in the UK are currently stating
that AIDS will bring about a decrease in population in a few decades
and this will lead to political disturbances in the continent of
transmission of AIDS through unprotected sex is blamed for the spread
of HIV and AIDS. Health education now teaches school children of
the dangers of sex without a condom.
"A condom is a small rubber bag. Everything coming from a man's
penis runs into this little bag."
to rebuild itself after two decades of civil war. A country that
can only afford under a dollar a year per person in health care,
opened its arms wide to international AID agencies. But the ensuing
flow of often exaggerated AIDS statistics that emerged from a multitude
of western research projects has backfired.
Makumbi (Minister of Health, Uganda): "I am concerned about
the interpretation of the picture of AIDS in Uganada, and this is
unfortunately arising from our strategy of coming out and speaking
openly about this disease, where some contries have preferred not
to publish the actual situation."
Okware (Deputy Director Medical Services, AIDS and Communicable
Diseases): "I think there has been of late a lot of exaggeration
about the extent to which AIDS is affecting Africa and Uganda in
particular. I think one of the reasons is that we have been very
open. We were the first African country to come out very openly
with a programme and this has somehow been misunderstood by some
people from the European countries, especially uninformed press
that this is the epicentre of AIDS. I don't think that's the problem.
I don't think that this is the epicentre of AIDS."
"People are trying to make a way of living out of this. You
know, they think that if they publicise it and they exaggerate it,
they might win sympathy of the international community and will
get aid, or rather get assistance from the - we need assistance
but not with the - I mean, not through bluffing people are dying
at the rate which is not true."
Bialy: "From both my literature review and my personal
experience over most of the AIDS - so called AIDS centres in Africa,
I can find absolutely no believable persuasive evidence that Africa
is in the midst of a new epidemic of infectious immunodeficiency."
So is there
an AIDS epidemic? If not, how is it people are being misdiagnosed
This is the
village of Rakai, described as the epicentre of the AIDS epidemic.
Villages like this we are told have been wiped out by the disease.
And AIDS is said to have started here, going on, to infect the whole
a typical victim of the AIDS panic. People think she has AIDS although
no one has ever tested her blood. Like so many thousands, she is
an AIDS case without any evidence. She is struggling to survive
but that is just as likely to be because she is starving, living
off scraps from her brother.
"I can hardly feed myself according to the salary that I get.
That means I'm running poverty. That's why you see me sleeping in
such a thatched house which is not good for my life. So now my worries
is poverty first. Secondly I lack food. Thirdly we don't get good
water. We don't get medicine. We don't get - let me say something
that keep someone alive."
sister and his family are locked into a cycle of poverty, acute
food shortage, dirty water and disease. In Africa, there are few
places where HIV tests are available. But on the basis of her symptoms
alone, Najemba still qualifies for an official AIDS diagnosis. She
has suffered combined symptoms of fever and diarrhoea for over a
month and she's had a dry cough.
"How do you feel?"
"I don't feel too bad but what I lack is things to drink."
"Do you think you have AIDS?"
"I can't be sure because the partners I've had are fine."
When we first
met Najemba two months earlier she had such bad infections on her
leg she couldn't walk at all. There was no way she could possibly
afford any antibiotics so we left her some money for medicines and
the leg infections have almost dried up.
The fact that
Najemba hasn't been able to pay her rent combined with the belief
that she has AIDS means she is now being forced out of her homein
the village. In her fragile condition she has been trying to build
a makeshift shelter in a malaria infested banana grove. She has
in fact been building her own tomb. If Najemba dies her death will
be blamed on AIDS but the real cause is more likely to be the destitute
living conditions in the Rakai.
village the total breakdown of the health and medical services is
only too apparent. We visited the local hospital in this so-called
epicentre of AIDS and found a sorry scene. Not a single AIDS patient
only an empty ward. No nurses, no doctors only one tiny baby suffering
from malaria convulsions surrounded by her silent family. We then
found the only member of staff who got up from her sick bed to speak
Maxensia: "I work as a midwife. And I also help in the
treatment of other patients."
"How do you feel?"
Maxensia: "Now I am sick."
"What do you have?"
Lack of staff
and medicines at these local hospitals and dispensaries has meant
that sick people simply stay in their own homes. But, Nurse Maxensia
did agree to show us the medicines cabinet stocked with some drugs
supplied free under the World Health Organisation Essential Drugs
Programme - however under a new cost-sharing scheme villagers are
now asked to pay a fixed rate for them which for most means going
don't even come. Before we put up that system we used to have a
lot of patients here. For one day...one fifty out-patients without
counting the inpatients."
Maxensia: "But now we get few."
"Because they can't afford to buy?"
Maxensia: "They can't afford to pay."
through Uganda took us through the Rakai region to the town of Kyotera.
We travelled with Ugandan radio journalist Sam Mulondo who has been
covering AIDS stories both in his country and in Europe. Here it
seems that the fear of AIDS is having as great an effect as AIDS
"'People are dying psychologically and the active cells, scientists
call it active cells, or something, psychological death. Many are
dying because of that. Somebody gets simple malaria, they fear to
go to the doctor, to see a doctor, just because they will be branded
with this clinical case as an AIDS or HIV. People are just left
at home, they don't go for any treatment whatsoever. Any slight
infection, people don't go to hospital. In addition to this area
lacking proper medical care facilities, people are worried about
the water they drink. They don't have treated water, t-piped water,
it's only from the springs, well which is contaminated as it rains
all sorts of, you know, contamination, goes into the springs and
well, they simple pick that water through these jerrycans, plastic
things, take home. Most of them they don't boil that water, they
just drink it."
capital, Kampala, Mulago Hospital's long tradition of excellence
in tropical medicine has made it a focal point for AIDS research
programmes. Here as in all African countries HIV tests are too expensive
for general use. AIDS is diagnosed through guidelines laid down
by the World Health organisation known as the 'Bangui clinical case
definition.' To qualify for AIDS someone must have a combination
of symptoms like persistent diarrhoea and fever for a month and
a dry cough. The trouble is that many of these symptoms are indistinguishable
from those of old established diseases like TB and malaria.
Ministry of Health did not allow us access to film patients inside
their hospitals. They were concerned about patient privacy and the
projection of too many negative images in the West. But we were
able to speak freely to the doctors.
At Old Mulago
Hospital, Dr. Martin Okot-Nwang is in charge of the TB wards.
He is concerned about the way TB and AIDS statistics are being wrongly
reported. TB is a disease that occurs where there is poverty, malnutrition
and lack of medicines. Conditions all rife in today's Uganda. Figures
have doubled recently in these wards.
Okot-Nwang: "We have just recently undergone through a
series of wars in this country, and this has led to a breakdown
in our health services. It's not unknown that following war famine
increases do occur, particularly in infectious diseases or communicable
diseases, of which TB is one of them."
The rise in
TB cases in Africa has led some scientists to speculate that the
HIV virus is making some people more susceptible to the disease
but it is hard to find any evidence for this. What IS documented
is that flaws in the clinical case definition, that is the combination
of symptoms used for diagnosing AIDS without an HIV test, have meant
that many TB cases have mistakenly been called AIDS.
Okot-Nwang: "A patient who has TB and is HIV positive would
appear exactly the same as a patient who has TB and is HIV negative.
Clinically both patients could present with long fever, both patients
present with loss of weight, marked loss of weight, both patients
who actually present with a prolonged cough, and in both cases the
cough could equally be productive. Now therefore clinically I cannot
differentiate with the two. Even when I look at the blood I may
find some similarities between the two groups."
In the past
TB of the lung or pulmonary TB was not considered a disease that
qualified as AIDS by the US Centres for Disease Control but it was
added to their list in January this year.
Okot-Nwang: "I think if they include pulmonary tuberculosis
as an AIDS defining case then all the TBs in Africa will - almost
all the TBs in Africa - will be AIDS."
in calling all TB cases AIDS means that money badly needed for the
treatment and cure of TB is being diverted into preventing the spread
Serwadda: "I think that there is to - there is a lot of
attention that has been paid to HIV and to the detriment of many
other diseases. And as less and less money becomes available, these
diseases themselves could become a public health hazard. Malaria
we are seeing a resurgence of malaria."
Mpeka: "Malaria is quite a big problem in Uganda. It's
the commonest disease in all parts of the country and it's the commonest
outpatient problem in all health units in this country."
"Is it curable?"
Mpeka: "Very much so. It's very curable. The drugs are
available. Chloroquine, which is still the cheapest is still effective."
"Are you able to supply the medicines that are really needed?"
Mpeka: "The, the supplies of medicines are not actually
adequate in most health units."
"Are you worried, etc..."
a very important point. We have periodically emphasised that research
of any kind, not only AIDS should have a component of patient care,
while we do agree that there should be a change in behaviour, and
that's a very important strategy. But it would be ridiculous to
leave people to die of tuberculosis."
"Are you able to persuade the foreign agencies to provide funding
for medication or are they reluctant?"
has been little compliance on the side of actual patient care. We
are having a lot of problems."
for the best documented data on HIV and AIDS took us across Africa
from East to West 3000 miles to Cote d'Ivoire. It's capital, Abidjan
has been chosen by many international agencies to further research
A stable political
environment, well developed health services infrastructure, meeting
place of different cultures and busy tourist trade have made it
a useful centre for research projects.
Manlan is Cote d'Ivoire's Director General for Health and Social
Manlan: "The situation concerning HIV infection and AIDS
in Cote d'Ivoire is the most serious in all of West Africa, as we
come sixth amongst all sub-Saharan countries and we are in first
place in West Africa in terms of prevalence."
epidemiologist Dr. Kevin De Cock heads a two million dollar a year
AIDS reseach project funded by the US Centres for disease control
or CDC. He is convinced that there is a mounting AIDS epidemic.
de Cock: "The problem is actually it is undermeasured.
If you don't measure how changes in - how patterns of mortality,
for example, are changing, you know. We've looked at it in Abidjan
and they've changed extraordinarily since the AIDS epidemic. With
a tremendous increase in death. In premature death. This is an epidemic
of historical importance. It is an epidemic that going to last for
decades, it may last more than a century."
of doom for Africa should perhaps be judged against similar predictions
that have long been made of an AIDS catastrophe in the West. Predictions
we now know to be greatly inflated. The committee appointed by the
UK government in 1988 predicted UK AIDS figures for '92 that were
over double what they turned out to be. In fact the only scientist
who has consistently predicted almost exactly the right figures
for the UK is Professor Gordon Stewart.
Stewart: "Now, because those predictions are so erroneous,
and because the methods used by and large are the same, I find it
very hard to understand why they place such confidence in those
estimates for Africa, even though the confidence limits are wide.
I mean at one extreme they'll say a very small number, the other
extreme a very large number, and saying that it's not easy in between
to decide what's going to happen, but that makes it all the more
important to avoid making those statements about - the sense of
doom about whole populations being exterminated. I can't see at
the moment that we have justification for saying this."
Dr. Havey Bialy
who has lived and worked in Africa is deeply sceptical of any current
AIDS claims about the continent.
Bialy: "Those claims are just that. They are based on no
real evidence whatsoever. In fact, the evidence could not really
exist because mortality figures for the continent of Africa have
never been kept as matters of record by the governments, even within
hospitals. These figures are extraordinarily difficult to come by."
One group that
is being closely observed is the prostitutes of Abidjan. Research
shows a much higher incidence of HIV than in the rest of the population.
Some of the women have been falling seriously ill and some have
died. But prostitution often goes hand in hand with hard drugs and
Abidjan's recent tourist boom has helped finance an escalating drugs
As yet there
is no useful evidence as to whether the prostitutes are dying of
HIV infection or drug addiction. Cote D'Ivoire Committee for the
Fight Against AIDS has just started a project amongst prostitutes.
Kale: "Yes, in this field it's true we have a big drugs
problem. We have to be very careful not to upset the sensitive work
that we are doing with this group."
"They smoke cocaine and heroin don't they? They smoke it?"
Kale: "Hashish is the most widely smoked drug. Cocaine
has been introduced into the country more and more. Heroin is very
tightly controlled, but, you know, it difficult to completely regulate
like Alice from Ghana are not convinced that it is sexually transmitted
HIV that is killing them. They believe it is the drug addicts amongst
them who are dying. Like the story of a Liberian friend who was
diagnosed with AIDS or SIDA as the French call it.
"Drug, she took drugs too much."
"So what happened?"
"She was sick?"
"Yes, if she smoke the drug, didn't job. No job."
"So, she went to the hospital."
"And then what happened?"
"They no have medicines, she died, for them."
"She died? Why did she have no medicine?"
"No have money."
"So she died?"
"And was that SIDA do you think?"
"What was it?"
"Well say the SIDA, the doctor come tell it's SIDA. It's not
"You don't think it was SIDA?"
"No, no, no..."
"What do you think it was?"
Bialy: "These girls are consuming hard drugs in a smokeable
form - namely, heroin and cocaine, in vilely adulterated versions
for the first time in the history of Africa. And these drugs began
to make their way into Abidjan in 1985-'86. They are epidemic amongst
certain classes of prostitutes right now, and these are the only
girls that are getting sick. It looks like AIDS because these girls
are wasted both because of the direct effect of the drugs and because
they use what little money they have on drugs, rather than on food."
in AIDS research in Abidjan has led to extensive testing for HIV.
Projects like this one at a maternity clinic in Koumassi have shown
a greater incidence of HIV in Africa than in the West. But what
they do not seem to be showing so far is a frequent progression
to AIDS. That is only the first of the puzzles.
80% of the
HIV positive mothers at this clinic are perfectly well. Jeanette,
for example, who is visiting the clinic today for a regular check
up and blood test for her baby, Ann.
Sibailly: "Generally speaking the two women we have just
seen this morning are asymptomatic. They have no signs of AIDS,
but the problem is, we don't know when they were infected. But what
puzzles us is the fact that many of the women who are classed as
negative fulfill, the definitions for AIDS."
director Dr. Georgette Adjorlolo has noticed that in the HIV positive
group there are marked differences in progression to AIDS.
Adjorlolo: "I have no doubt that the HIV virus is the cause
of AIDS. But we are seeing differences in progression to AIDS, and
these observations lead me to think that it's not only HIV - but
certain co-factors that accelerate the onset of the disease - and
maybe other factors such as nutrition, and concurrent infections."
Manlan: "The virus is only a co-factor. One can perhaps
say that progression to AIDS is not inevitable - that many people
may encounter the human immunodeficiency virus, some will get AIDS,
and others will not. One must therefore consider that there are
several factors which we have to identify to improve our understanding
of the disease and also to improve the way in which we wish to fight
The more research
funding that is put into Africa the greater the anomalies that emerge.
Does HIV need triggers to turn into AIDS ? Can you have AIDS without
HIV ? Can you live with HIV and not get AIDS ? Our search took us
on to Cameroon.
International African AIDS Conference held in Yaounde, Cameroon.
Here the emphasis is almost exclusively on controlling AIDS by controlling
the sexual spread of HIV. The conference attracted over two thousand
delegates from all over the world.
was first diagnosed in the United States in the early eighties,
many still look to Africa for the origin of the disease, blaming
the African green monkey and African sexual practices. But, as more
is understood about the disease the western model of AIDS seems
to have less and less in common with AIDS in Africa. In the West,
90% of its victims are male; in Africa nearly half of the diagnosed
cases are women.
for AIDS caused puzzlement at first and then outright anger amongst
Chirimuuta: "There were many many examples but one example
is that African gave their children dead monkeys to play with as
toys and there was all this nonsense about how promiscuous Africans
were than, any other humans. I mean, I could go on and on. I mean
and that African believe that the only cure for AIDS was to sleep
with virgins and this is why AIDS was so widespread in Africa. Most
of them were all based on racism or racist preconceptions of Africans.
The allegations really that Africans were more promiscuous than
the rest of the human race were unfounded. They didn't make any
sense scientifically. In fact when they sent teams of researchers,
sociologists, anthropologists to Africa, they were amazed that Africans
were actually much more conservative in their sexual practices."
A focal point
of the conference was the need to change sexual practices and how
to encourage the use of condoms.
"You see there is the tank. This is the tank where the sperm
will remain after ejaculation. You hold like this. And gently it
goes down, make sure this one you press the tank gently. And there
conference was a grand affair, drawing together all the national
and international dignitaries of the AIDS round.
the scenes a French charity worker called Philippe Krynen was photocopying
his protest pamphlets down the road - pamphlets critical of the
AIDS hype he has experienced in Africa. He is angry at the way exaggerated
figures for the prevalence of HIV in his area of Tanzania are causing
distress and even death in his communities, so he decided to test
an entire village and called a press conference here in Cameroun
to announce the results.
Krynen: "We got a whole village coming forward to volunteer
to know - you know what ? To know if they are going to die. What
is important is to see that these declared cases of deaths from
AIDS have not increased. In this village particularly since two
We went to
visit Philippe across the Ugandan border into the Kagera region
of Tanzania. Philippe was waiting for us across the border. He is
director of Partage, a French charity that supports, through individual
sponsorship, orphan children in this remote region. Orphan in this
part of Africa means a person under 18 who has lost one or both
parents. It can also refer to children with special needs. Philippe
travels constantly and has noticed that the number of so-called
AIDS deaths is diminishing in this area.
Krynen: "We see that the casualties because of AIDS with
the diseases which are called AIDS here which are similar to the
symptoms of AIDS, they are less and less since now two years."
his wife Evelyne have based themselves in Bukoba a once prosperous
town on the edge of Lake Victoria that has fallen out of political
favour over the years and is suffering increasing poverty and neglect.
Here Partage provides medical care, schooling and support to children
in fifteen villages spread over a vast region spanning over 1000
square miles. So great has been the fear of AIDS in this community
that Philippe has found it difficult to generate community support
for the orphan children.
Krynen: "How can you ask people who believe they are going
to die tomorrow, how can you ask them to look into the future which
are the children. They give up, they don't invest. They don't want
to come to work in northern Kagera because they think that they
are going to die of AIDS, or to contract it."
campaigns have been particularly successful in this region leading
most people to believe they could be infected. Philippe decided
to get at the facts. First he asked all of his 160 workers if they
would volunteer for confirmed HIV tests. He found 5% were positive.
Then a whole village of 842 people volunteered. He found 13.8% were
positive. These figures are higher than estimates for the number
of HIV positives in the West, which are less than 1%, but substantially
lower than previous estimates for this region of Tanzania.
Krynen: "This is the first time in Africa that a village
has volunteered as a whole to be tested for a deathful disease.
That everybody has got his results and that the truth has been five
times lower than the figures given by the World Health Organisation
of the AIDS control programmes."
the shattered confidence and morale in this region has required
Lucy is an
orphan who was working as one of Philippe's trainees. She became
ill with repeated infections and lost over 20 pounds in weight.
Most people thought she had AIDS.
"I was very ill at home when Mr. Philippe came to the village
Mwambele led him to my house. Mr. Philippe was worried and took
me to hospital."
that Lucy had been diagnosed as HIV positive in an unconfirmed screening
test. He and his wife decided to support Lucy and help her regain
her position in the community. They moved her out of her small hut
and built a new house for her.
Krynen: "And slowly in four five months time, Lucy started
top recover, to put weight. Supplemented with vitamins, supplemented
with food, with a better salary. And because she had put weight
again, and she had been freed of skin diseases, her friends started
to look at her differently. Not putting her on a side and not being
afraid of her. Because they started to question if really she had
AIDS or not. It's very seldom you see people who have been stigmatised
with AIDS, who are not dying a few months later. So, Lucy was one
of the first persons who, because we didn't support the AIDS tag
on her, recovered and was proof to the community that you can recover
for - from such episodes."
"I am strong and I'm back to my old weight. So, I can do any
work I'm faced with."
"What would you like to see happen?"
"I hope to have children."
In three successive
tests Lucy has now been found to be HIV negative. She is just one
example of the mass of flawed HIV statistics that bedevil Africa.
Her unconfirmed screening test would have been included in the official
reported figures for HIV positives.
Bialy: "Some of these tests are so non-specific that 80
- 90% of the positives that are picked up are false positives. They're
reacting to antibodies that are not HIV specific. And when one realises
that these tests are being pushed in a context in which we have
to test as many people as possible, the inevitable outcome is that
Africa - the figures for numbers of HIV infections in Africa will
become wildly exaggerated and feed into a very, very deadly self-fulfilling
official figures, over a period of 8 years in the United States
there's been a relatively stable estimate of 1 million HIV positive
people. The total number of reported AIDS cases is 250,000. In subsaharan
Africa, as testing has increased, the estimated HIV positive total
has risen to six million people (six times the US figures). But
the total number of reported AIDS cases is only 129,000 - (half
the US figure).
between HIV and AIDS here and in the West is dramatic but the single
most obvious fact about AIDS and HIV statistics in Africa is that
they are unreliable and virtually useless in charting the course
of AIDS. HIV figures are flawed because the tests are unreliable,
giving too many false positives.
AIDS through the Bangui case definition, by looking for a combination
of several symptoms, is also flawed because so many other diseases
get swept into the net.
Does the African
experience of AIDS help our understanding of AIDS in the West ?
One who thinks it does is molecular biologist Professor Peter Duesberg.
He has argued for six years that HIV is not the cause of AIDS. In
leading science journals he develops his view that HIV is no more
than a passenger or hitchhiker that's around, like other bugs, when
people are at risk - a bug that's dormant rather than fatal. And
he points to one anomaly in particular in Africa's statistics that
he believes supports his theory - more than two thousand documented
cases of AIDS without HIV.
Many of these
cases come from Dr. Kevin de Cock's studies in Abidjan'a three main
hospitals. There over one third of cases NOT qualifying as AIDS
under the Bangui definition of symptoms were HIV positive and one
third of cases which DID qualify as AIDS were HIV negative. How
does Dr. de Cock explain the cases in his study which have been
diagnosed as AIDS cases but when tested have been found not to have
de Cock: "If we're talking about AIDS we should perhaps
scrap that word and talk about HIV disease. Alright. It's very clear
what is HIV disease. Now it is not surprising that the constellation
of symptoms, signs, and indeed, opportunistic infections, occasionally
- occasionally occur in people without HIV infection."
Bialy: "There are thousands of documented cases from the
Third World, from Africa in particular, of clinically reportable
AIDS in which HIV testing has been done and found to be negative.
I think it's amongst the strongest arguments that HIV is irrelevant
to the development of AIDS in at least some cases if not all cases."
Dr. de Cock
maintains that those HIV negative cases may have looked like AIDS
but they were simply conditions which were drawn into the net when
collecting numbers of patients for resarch purposes and not for
"These 2400 cases were called AIDS, for all intents and purposes,
in all the literature. And yet you're saying they shouldn't have
been called AIDS. But they were identical to AIDS. So, are you saying..."
de Cock: "But they were HIV negative."
"So, are you saying there have been 2400 misdiagnoses?"
de Cock: "Are you talking about - we're talking about the
quality of surveillance data."
"The documented cases of full blown AIDS which, when tested,
were HIV negative."
de Cock: "Well then they're not AIDS cases. They're not
AIDS in the way we talk about HIV disease."
"But they were called AIDS in the documents. They were called
clinical case definition Bangui AIDS. Do you see?"
de Cock: "Of course I see. Any case definition particularly
one which is clinically based is not going to be perfect."
Bialy: "When one has clinically identical pictures one
with HIV antibodies, one without HIV anti-bodies - to call one AIDS
and one not AIDS is patent absurdity. This is irrefutable proof
that HIV is not necessary for the presence of AIDS, except by definition."
the external debt now stands at $ 570 million. The interest payments
on these debts amount to twice the total annual health budget, which
is about half of one per cent of the Gross Domestic Product.
There is a
crying need to call on health funding from outside - the trouble
is HIV prevention is swallowing most of it up. In 1992 Uganda's
total budget for malaria treatment and control was less than $ 57,000
yet foreign funding for AIDS was over $6 million dollars.
intentioned, AIDS funders also have their own agendas. The American
government's aid agency US AID's genuine desire to help prevent
the spread of HIV by funding counselling and condom distribution
coincides with its declared interest in population control. It's
investment in HIV prevention is huge.
"In the next five years AID plans to devote hopefully as much
as $ 400 million for prevention activities worldwide. Much of that
will go to Africa to help develop larger, more comprehensive and
integrated programmes that we hope will be able to show to the world
that you can make an impact on behavior change and we can make an
impact on slowing down the spread of HIV transmission."
"There has been some criticism that US AID's policy in Africa
of distributing condoms suits US AID's policy for population control
and this is worrying some African spokespeople. What is your view?"
"AID has always had a very strong emphasis on population. But
condoms have never been, the contraceptive of choice for population
programmes and so condom use in population programmes has not been
Makumbi: "We have about - more than 700 non-government
organisations, operating in the AIDS field in Uganda. This raises
a lot of concern, because a few of them are doing a very good job.
But a good number of them, my ministry is not aware of what they're
actually doing, and there is no way of evaluating them. Unfortunately
a good number of them do rush in, collect data, and go away with
it, and the next we hear about it is when it is being printed in
journals, and we have not had any imput and some of this work has
been done in very limited areas, not reflecting the rest of the
At Mulago Hospital
senior lecturer, Dr. David Serwadda is not at all happy with the
wayresearch projects have been conducted in Uganda, and in 1990
published his criticisms of western researchers in The Lancet.
Serwadda: "I'm concerned about who is setting the priority.
Two, the main results who - the implications of the results, how
applicable are they and how relevant they are to our environment.
And three the training during the course of the execution of the
research - to train the local individuals so that at the end of
the research, there is some local manpower that is trained to be
able to carry on independent research."
has told us he keeps an open mind as to whether HIV is the cause
of AIDS and is conducting his own research in the Rakai District
with a team from Mulago Hospital. Contrary to previous reports,
he has found a lower than expected incidence of HIV - at 12.6%.
Almost the same as Philippe Krynen's findings in the neighbouring
region of Tanzania. Another of his projects involves following up,
one hundred 'discordant' couples where one partner is HIV positive
and the other negative.
Serwadda: "The results of the study so far shows that in
only five pairs have both individuals become positive. This was
a pleasant surprise because I had expected a much higher set of
Serwadda: "Which means both couples becoming positive over
a two year period."
If HIV were
one day found not to be the cause of AIDS then the consequences
for Africa and Africans of following the HIV hypothesis would have
been grave indeed.
Okot-Nwang: "What keeps a man energetic and keeps them
doing what they do is their hope for the future. But once you tell
me that I am HIV positive then you have given me this message that
you are going to die, and therefore I have no energy for the future."
In spite of
everything, life and love goes on in Uganda and even those who believe
HIV does play a role in AIDS have strong messages of hope for the
Okware: "You see the majority of our people here are children
who are below the age of 19, and these are more than 50 percent
and they're all negative, most of them are negative. If you look
at the seropositivity, incidents or prevalence of AIDS cases here
in this country you'll find that not more than six percent of the
general population is affected. Now six percent leaves 94 percent
of the population completely able to perform what should have been
done by the rest of the population. So, I don't think AIDS really
in the long run will completely mutilate and disintegrate Africa."