# Castro Hlongwane, Caravans, Cats, Geese, Foot & Mouth and Statistics: HIV/Aids and the Struggle for the Humanisation of the African

CASTRO HLONGWANE, CARAVANS, CATS, GEESE, FOOT & MOUTH AND STATISTICS HIV/AIDS and the Struggle for the Humanisation of the African
March 2002

## Prelude

   "And Conrad's stand-in, Marlow, (in Heart of Darkness), muses on how 'the conquest of the earth, which mostly means the taking it away from those who have a different complexion or slightly flatter noses than ourselves, is not a pretty thing when you look into it too much."
(King Leopold's Ghost by Adam Hochschild, Houghton Mifflin Company, New York, 1998.)
   "All the human race loves a lord – that is, it loves to look upon or to be noticed by the possessor of Power or Conspicuousness; and sometimes animals, born to better things and higher ideals, descend to man's level in this matter. In the Jardin des Plantes I have seen a cat that was so vain of being the personal friend of an elephant that I was ashamed of her."
(Does the Race of Man love a Lord?, by Mark Twain, April 1902: Mark Twain, The Library of America, 1976.)
   "The failure of American AIDS to 'explode' into the general population led the authorities to look for the phenomenon elsewhere. New AIDS cases in the U.S. began falling before the introduction of 'protease inhibitor' therapy, and from 1997 to 1998 dropped from about 60, 000 to 48, 000. Of teenagers diagnosed in 1998, only 68 were classified as 'heterosexual contact.' Among women, AIDS diagnoses fell from 13, 000 in 1997 to 11, 000 in 1998... If the very high AIDS spending by the U.S. government is to be sustained, the emergency would have to be drummed up elsewhere... so Africa beckoned."
(Inventing an Epidemic, The American Spectator, 2000, by Tom Bethell, Washington Editor.)
   "In money terms, first there is the pharmaceutical industry. If AIDS in Africa is now a national security threat, as President Clinton has declared, American money will be appropriated for the very expensive drugs to spend in Africa – billions of dollars of potential profits. If Washington doesn't appropriate funds, there's the fear that African nations might buy generic, foreign-made copies of U.S. drugs. Then there is the public health establishment. More billions can go for salaries, offices, staffing, travel and long reports. The World Health Organisation budget has skyrocketed along with African AIDS statistics. Many public health officials are well meaning, seeing AIDS fears as the only way to get money to help the misery afflicting so much of Africa. In America, government AIDS money is spreading far and wide. Federal spending now tops $10 billion and is increasing yearly even as case loads fall."
(AIDS Hype in Africa? No HIV Test Required, Disease Defined Differently Than in U.S., by Jon Basil Utley, Robert A. Taft Fellow at the Ludwig von Mises Institute, USA, April 30, 2000.)
"Africa Can't Just Take a Pill for AIDS"; New York Times (www.nytimes.com) (07/06/00) P. A27; Goldyn, Lawrence.
   "Lawrence Goldyn, a doctor who treats HIV-positive patients, writes in an editorial that South African President Thabo Mbeki has frustrated AIDS researchers with his decision not to promote the use of the drug AZT and his consideration that HIV may not cause AIDS. However, in the light of the country's poor infrastructure, these decisions are rational. South Africa lacks the resources and pharmaceuticals to treat its growing HIV-infected population. Cocktail drugs cost up to $15,000 a year, not affordable for most, and unavailable without the social, economic, and medical structures needed to administer drug therapies. The complicated treatments for HIV require full adherence and stability, and getting South Africans to follow a drug schedule could be impossible, based on the past failure of tuberculosis treatments. Transmission of HIV to newborns is also an issue, but in a country where breast-feeding is the only option, the infection rate is 30 per cent for infants born to an infected mother. The best solution is an AIDS vaccine, but without research funds that turn profits, it is years away. Mbeki is right to say that the Western way of fighting AIDS will not transfer to Africa."
Current TB News: Week of July 10, 2000: Johns Hopkins Center for Tuberculosis Research.
   "As my journey through the pharmaceutical jungle progressed, (in which a number of people were murdered, others killed with experimental drugs, and governments and universities corrupted), I came to realise that, by comparison with the reality, my story was as tame as a holiday postcard."
"The Constant Gardener" by John le Carre. (Author's Note): Coronet Books, Hodder and Stoughton, London. 2001.

## Preface

This monograph discusses the vexed question of HIV/AIDS.
It is based on the assumption that to understand this matter, it is necessary to study it.
It does not accept the assertion that only scientists and medical doctors are capable of understanding this medical condition. Written essentially by non-scientists, it nevertheless seeks to understand the scientific logic of the thesis of HIV/AIDS.
It accepts that there are many unanswered scientific questions about the HIV/AIDS thesis and many hypotheses about this matter that are falsely presented as facts.
It recognises the reality that there are many people and institutions across the world that have a vested interest in the propagation of the HIV/AIDS thesis, because they have too much to lose if any important element of this thesis is proved to be false.
It accepts that these include the pharmaceutical companies, which are marketing anti-retroviral drugs that can only be sold, and therefore generate profits, on the basis of the universal acceptance of the assertion that "HIV causes AIDS".
It also accepts that among those that share the vested interests of these companies are governments and official health institutions, inter-governmental organisations, official medical licensing and registration institutions, scientists and academics, media organisations, non-governmental organisations and individuals.
It recognises that there are many well-meaning institutions and individuals in our country and the rest of the world who have innocently accepted and propagate the positions advanced by those who share these vested interests.
It accepts that these have to be exposed to the truth, in the conviction that their consciences will enable them to side with the truth against the untruth, provided that they are informed of the truth.
It also accepts that the HIV/AIDS thesis as it has affected and affects Africans and black people in general, is also informed by deeply entrenched and centuries-old white racist beliefs and concepts about Africans and black people. At the same time as this thesis is based on these racist beliefs and concepts, it makes a powerful contribution to the further entrenchment and popularisation of racism.
It further recognises the reality that, driven by fear of their destruction as a people because of an allegedly unstoppable plague, Africans and black people themselves have been persuaded to join and support a campaign whose result is further to entrench their dehumanisation.
In this context, it recognises the reality that in our own country, the unstated assumption about everything to do with HIV/AIDS is that, as a so-called "pandemic", HIV/AIDS is exclusively a problem manifested among the African people.
It recognises the fact that for the whole truth to emerge, and nothing but the truth, a difficult struggle will have to be waged to overcome the determined resistance of those who have a vested interest in the perpetuation and entrenchment of the currently dominant HIV/AIDS propositions.
It also recognises the frightening and dangerous reality that some of those who share this vested interest are ready and willing to do everything in their power to ensure that their view prevails, globally. This includes the use of any means and measures whatsoever, with no holds barred, to destroy and remove all those who oppose them.
It therefore warns that those who open their minds to what is contained in this document as a whole should understand that they expose themselves to many hazards and dangers that may pose a threat to their careers, their future and their lives.
The monograph accepts that our people, and others elsewhere in Africa and the rest of the world, face a serious problem of AIDS.
It accepts the determination that AIDS stands for Acquired Immunodeficiency Syndrome.
It accepts that a Syndrome is a collection of diseases. It proceeds from the assumption that the collection of diseases generally described as belonging to the AIDS syndrome have known causes.
It rejects as illogical the proposition that AIDS is a single disease caused by a singular virus, HIV.
In other words, it accepts that AIDS is either a syndrome or a disease. It cannot be both. Its acronym correctly describes it as a syndrome. For this reason, it is not described as AIDD.
It accepts that an essential part of AIDS is immune deficiency. This constitutes the ID in AIDS.
It accepts that this immune deficiency may be acquired, accounting for the A in AIDS.
It asserts that there are many conditions that cause acquired immune deficiency, including malnutrition and disease.
It therefore argues that, in our situation, many and varied interventions have to be made to protect and strengthen the immune systems of our people.
It accepts that these include attention to our nutrition and the eradication of the diseases of poverty that afflict millions of our people.
It accepts that a vaccine should be developed to strengthen the immune system so as to reduce its exposure to the possibility of deficiency.
It accepts that HIV may be one of the causes of this immune deficiency, but cannot be the only cause.
It accepts the proposition that currently existing kits used to check the existence or otherwise of HIV give a "positive" result in response to a variety of medical conditions.
Accordingly, it accepts the assertion that these kits do not establish the presence or absence in the human body of HIV.
It accepts the proposition that these kits detect the presence of antibodies produced by the immune system to fight conditions in the human body that the immune system identifies as a threat to good health.
It rejects as baseless and self-serving the assertion that millions of our people are HIV positive.
It supports the proposition that correct medical practice demands that each person should be treated for any illness identified through clinical examination, regardless of their "HIV status".
It therefore rejects the condemnation of people to a slow death on the basis that they are HIV infected, which condition cannot be reversed.
It accepts the proposition that anti-retroviral drugs can neither cure AIDS nor destroy the HI virus.
It therefore rejects the suggestion that the challenge of AIDS in our country can be solved by resort to anti-retroviral drugs.
It rejects the assertion that, among the nations, we have the highest incidence of HIV infection and AIDS deaths, caused by sexual immorality among our people.
It rejects the claim that AIDS is the single largest cause of death in our country.
It argues that we must understand properly and comprehensively the burden of disease and death in our country and ensure that we follow appropriate health and other policies to address this burden, including treatment.
It accepts that the pursuit of the objective of health for all must continue to be one of the central objectives of our government and society.
It argues that while those who have commercial and political interests in the promotion of anti-retroviral drugs, and insulting our people, pursue an agenda aimed at minimising and denying the real causes of illness and death in our country, we have a responsibility to understand these real causes of illness and death.
It rejects the argument to "break the silence" about AIDS by imposing the silence of the grave about diseases of poverty.
It is opposed to the medicalisation of poverty.
It argues that an all-round approach should be adopted to deal with AIDS, focusing in particular on prevention of any infection or condition that might lead to immune deficiency, including sexually transmitted diseases.
It argues that an all-round approach should be adopted to deal with all diseases that affect our people.
It is based on the proposition that each one of our citizens has a responsibility to take all necessary measures to protect his or her health.
It rejects as fundamentally incorrect and anti-democratic the attempt to transfer the responsibility to look after oneself to the state, which seeks to turn the state into an omnipotent apparatus that must even police the sexual activities of every individual South African.
It asserts that it is important that the government and society as a whole should ensure that the citizen has all the necessary information to be able to discharge the responsibility to conduct himself or herself in a responsible manner.
The monograph accepts the responsibility of the state to do everything it can to provide adequate and affordable health care for all our citizens. This must include treatment of the so-called opportunistic diseases, including TB and STD's.
It argues for loyalty to the truth and a refusal on the part of the government and the people to succumb to pressures that are directed at serving particular commercial and political interests at the expense of the health of our people.
It rejects the assertion that, as Africans, we are prone to rape and abuse of women and that we uphold a value system that belongs to the world of wild animals, and that this accounts for the alleged "high incidence" of "HIV infection" in our country.
It enjoins all our people to think for themselves, refusing to be intimidated or terrorised by those who have powerful voices and the backing of the fabulous wealth we do not have, because we are poor.
It recognises that the effort it took to produce this monograph will only be meaningful to the extent that we, as Africans, have the courage, integrity and self-confidence to think and act independently and correctly, in our own interest.
It accepts that ours are a courageous, principled and confident people, who have demonstrated these qualities over many centuries.
The monograph is based on the recognition of the fact that the HIV/AIDS issue is both scientific/medical and profoundly political.
It accepts the proposition that despite the reality that our world is driven by a value system based on financial profit and individual material reward, the notion of human solidarity remains a valid precept governing human behaviour.
The monograph seeks to advance the cause both of better health for all our people and the recovery of our dignity as black people and human beings. These are fundamental to our very being as a movement and a people and therefore do not permit of any compromise.

## Chapter I

As the 19th century came to a close, in 1900, the great pan-Africanist, W.E.B. du Bois, said that the problem of the 20th century was the problem of the colour line. During the last year of this 20th century, 2000, our President, Thabo Mbeki, was asked to open the Durban 13th International AIDS Conference, which he did.
On reporting this event, the media said that hundreds of delegates walked out of this opening session both because of what the President said and what he did not say. Let us quote what he said.
   "Let me tell you a story that the World Health Organisation told the world in 1995. I will tell this story in the words used by the World Health Organisation.
   "This is the story: The world's biggest killer and the greatest cause of ill-health and suffering across the globe is listed almost at the end of the International Classification of Diseases. It is given the code Z59.5 - extreme poverty.
   "Poverty is the main reason why babies are not vaccinated, why clean water and sanitation are not provided, why curative drugs and other treatments are unavailable and why mothers die in childbirth. It is the underlying cause of reduced life expectancy, handicap, disability and starvation. Poverty is a major contributor to mental illness, stress, suicide, family disintegration and substance abuse. Every year in the developing world 12.2 million children under 5 years die, most of them from causes which could be prevented for just a few US cents per child. They die largely because of world indifference, but most of all they die because they are poor.
   "Beneath the heartening facts about decreased mortality and increasing life expectancy, and many other undoubted health advances, lie unacceptable disparities in wealth. The gaps between rich and poor, between one population group and another, between ages and between sexes, are widening. For most people in the world today every step of life, from infancy to old age, is taken under the twin shadows of poverty and inequity, and under the double burden of suffering and disease.
   "For many, the prospect of longer life may seem more like a punishment than a gift. Yet by the end of the century we could be living in a world without poliomyelitis, a world without new cases of leprosy, a world without deaths from neonatal tetanus and measles. But today the money that some developing countries have to spend per person on health care over an entire year is just US $4, less than the amount of small change carried in the pockets and purses of many people in the developed countries.
   "A person in one of the least developed countries in the world has a life expectancy of 43 years according to 1993 calculations. A person in one of the most developed countries has a life expectancy of 78, a difference of more than a third of a century. This means a rich, healthy man can live twice as long as a poor, sick man...
   "HIV and AIDS are having a devastating effect on young people.
   "In many countries in the developing world, up to two-thirds of all new infections are among people aged 15-24. Overall it is estimated that half the global HIV infections have been in people under 25 years with 60% of infections of females occurring by the age of 20. Thus the hopes and lives of a generation, the breadwinners, providers and parents of the future, are in jeopardy."
Because he said all these things, it was said that hundreds of delegates walked out on President Mbeki!
They also walked out because there were two things he did not say. One of these was that he did not say that HIV causes AIDS! The other was that he did not say that HIV/AIDS is the single greatest threat to the survival of the peoples of sub-Saharan Africa!
Instead, he concluded his address with the words:
   "The world's biggest killer and the greatest cause of ill health and suffering across the globe, including South Africa, is extreme poverty.
   "Is there more that all of us should do together, assuming that in a world driven by a value system based on financial profit and individual material reward, the notion of human solidarity remains a valid precept governing human behaviour! On behalf of our government and people, I wish the 13th International AIDS Conference success, confident that you have come to these African shores as messengers of hope and hopeful that when you conclude your important work, we, as Africans, will be able to say that you who came to this city, which occupies a fond place in our hearts, came here because you care. Thank you for your attention."
Offended both by what he said and what he did not say, reportedly hundreds of delegates who undoubtedly consider themselves to be friends of the Africans, walked out on the President.
The great puzzle is why these friends of the Africans found the truth, as told by the WHO, so unpalatable. Medical science everywhere in the world recognises the central importance of diseases of poverty.
As we will demonstrate later, even the most highly developed countries in the world are themselves involved in a struggle against diseases of poverty within their own borders.
For some strange reason, Africa, among the poorest continents of the world, is not supposed to talk about these diseases of poverty and to focus on their eradication. We are urged from all sides to break the silence about HIV/AIDS and maintain perfect silence about the diseases of poverty.
To what do we owe these strange goings-on!
The war to defeat AIDS is also a war to defeat the humiliation and dehumanisation of the African people.
This humiliation and dehumanisation 'is not a pretty thing when you look into it too much.'
When the humiliated and dehumanised speak of it too much, some friends of the African judge such conversation as not being a pretty thing. Discussion then becomes impossible.
The war to defeat AIDS is a difficult struggle because it is not only a struggle against the conditions that produce ill health and unnecessary death among millions of Africans, challenging as this struggle is.
It is a difficult struggle also because it has to be waged against some friends of the African, who find that the truth is not a pretty thing.
Asserting that they stand on irrefutable scientific knowledge, these particular friends of the Africans, and the Africans themselves, are horrified beyond measure that the Africans will perish, consumed by an HIV/AIDS pandemic which is sweeping across the face of Sub-Saharan Africa.
Statistics are produced regularly to show rapidly growing HIV infections and rapidly growing deaths from HIV/AIDS on our continent.
Our friends claim that millions of Africans, in increasing numbers, are infected with a highly mutant and indestructible Human Immunodeficiency Virus. They say that this HI Virus is communicated from person to person through heterosexual intercourse and from mother to child. To stop the spread of the Virus, they say that the Africans should abstain from sexual intercourse or use condoms.
They also say that HIV-positive mothers should be given drugs to stop the transmission of the Virus. Their babies, too, should be given the same drugs, presumably to kill the Virus if the mother has nevertheless transmitted it.
They urge that in the event of rape, the victims should also be given drugs, in case the rapist/s is or are carriers of the HI Virus.
They argue that all the above conforms, unequivocally, to the best available scientific knowledge. It is therefore unquestionable. Diagnosis, prevention and treatment are all based on immutable scientific truths that were agreed by the global scientific community 20 years ago.
It is then said that to question any of the above, or to ask any questions whatsoever, is to commit the sacrilege of questioning science itself and take on the guilt of the perpetration of the high crime of genocide. The message is simple to understand and communicate. If it moves – clothe it in a condom! If it was naked – destroy its diseased emission with drugs!
The message is also simple in another way. The assertion is made that scientific discoveries about HIV and AIDS were proclaimed two decades ago. At the moment of the proclamation, the science of AIDS came to a standstill. It was frozen at this particular moment into an unquestionable and unchangeable monument to scientific thought.
Accordingly, further scientific inquiry into this matter is impermissible.
Such scientific knowledge as was possible two decades ago must be supported by all and sundry, including scientists, as part of a religious dogma. Accordingly, to establish his or her credentials, everybody must answer the ballad question – do you believe that HIV causes AIDS! Belief about a scientific matter, and not empirical evidence, thus becomes the criterion of truth.
In his book, "Eros & Civilisation", (Sphere Books, London: 1970), Herbert Marcuse wrote of our epoch as "a period when the omnipotent apparatus punishes real non-conformity with ridicule and defeat... "
And so it has come to pass that anybody who has dared to question any of the above allegedly established scientific truths, has been confronted by this omnipotent apparatus. Accordingly, it has punished non-conformity with ridicule, defeat and worse.
Elsewhere in the same book, Marcuse writes:
"The primal father, as the archetype of domination, initiates the chain reaction of enslavement, rebellion, and reinforced domination which marks the history of civilisation. But ever since the first, prehistoric restoration of domination following the first rebellion, repression from without has been supported by repression from within, the unfree individual introjects his masters and their commands into his own mental apparatus. The struggle against freedom reproduces itself in the psyche of man, as the self-repression of the repressed individual, and his self-repression in turn sustains his masters and their institutions."(Our emphases).
In our case, it would seem that this is precisely what the "omnipotent apparatus" has achieved. The defeat and repression of the non-conformists is sustained by repression from within. The unfree individuals, the Africans, have introjected their masters and the commands of the masters into their own mental apparatus. Thus do they sustain their masters, their ideas and their institutions.
In his Political Preface 1966 to this book, Herbert Marcuse says:
   "The people, efficiently manipulated and organised, are free; ignorance and impotence, introjected heteronomy (the internalisation by the 'unfree' as the true exercise of individual autonomy of the practice of seeming to make an independent determination of choices, which are, in reality, pre-determined by another – Our annotation) is the price of their freedom."
He goes on to say:
"What started as subjection by force soon became 'voluntary servitude', collaboration in reproducing a society which made servitude increasingly rewarding and palatable... Today, this union of freedom and servitude has become 'natural' and a vehicle of progress."
Mark Twain put this differently when he said the 'all the human race loves a lord... In the Jardin des Plantes I have seen a cat that was so vain of being the personal friend of an elephant that I was ashamed of her.'

## Chapter II

Perhaps in citing these passages, especially from "Eros & Civilisation", we have moved forward far too quickly in terms of the presentation of our narrative, which the omnipotent apparatus views and denounces as non-conformist.
Let us therefore retrace our steps and, as it were, begin from the beginning.
The Book of Genesis in the Holy Bible, says:
   "And God said, 'Let there be light,' and there was light. God saw that the light was good, and he separated the light from the darkness."
Taking example from this, though disadvantaged by the fact that we do not have the power of the Creator, we trust that what we present in this brief discourse will help all of us to separate the light from the darkness with regard to the issue of AIDS. This may be difficult. It is, nevertheless, critically important.
Given that our minds on this matter have become thoroughly clogged by the information communicated by the omnipotent apparatus, a miracle will have to be achieved to get all our people to use their brains, rather than perish on emotional responses based on greatly heightened levels of fear.
In reality, as will become clear, what we are about is the cleaning of the Augean stables that constrain the African mind. Let us present our first scientific fact.
The first report on the incidence of HIV in South and Southern Africa was published in the "New England Journal of Medicine" and the "South African Medical Journal", both in 1985.
Two of the most important findings in this report were that in our country and region:
* HIV infection was confined to male homosexuals; and,
* HIV was not endemic in this region of the world.
To quote this report, it said:
   "The only positive subjects were in the group compromising male homosexuals. The majority of these positive subjects had either recently been to the United States or had had sexual contact with other homosexuals who had visited the United States... Our preliminary data show that the agent implicated in causing AIDS, HTLV-III (later named HIV), is not endemic in this part of Africa."
During the same year, October 1985, German researchers had an article published in the British medical journal, The Lancet. They stated that:
"the data suggest that HTLV-III was rare in Africa until recently, and still is rare in much of the continent."
Some of our friends, the friends of the Africans, say that five years later, this situation had changed completely. They say that now, in our region and country, the HI Virus was transmitted heterosexually and that it had become endemic.
The point made in the 1985 report about male homosexuals and HIV coincided with what science said about the incidence of HIV in the United States and Western Europe at the time.
To all intents and purposes, 15 years later, this situation has not changed both in the US and in Western Europe. But, as we have said, and as is generally known, our own situation has changed radically, resulting also in it being said that we now have the highest incidence of HIV or the spread of HIV in the world.
The question that arises from this is – why! Why does the same Virus behave differently in the US and Western Europe from the way it behaves in Southern Africa!
It would seem obvious that this question must be asked. If we are interested in the advance of scientific knowledge, the better to understand the African human condition, it is imperative that an answer be found.
It would seem equally obvious that for us successfully to deal with the HI Virus as it affects us, we need to understand what induces it to behave differently in different parts of the world.
In answer to these questions, some of our friends, the friends of the Africans, say that we are affected by a particular type or variant of the HI Virus, which is unique to ourselves and which also mutates at a high frequency rate.
However, this answer throws up new questions. Why is this special type of HI Virus confined only to our region of the world! Why does it not spread to other areas, even within Africa! What happened to the 1985 South African HI Virus which behaved in the same way as the US and West European HI Virus! If it mutated into what it is today, why did it not mutate in the same way in the US and Western Europe!
Once more, scientifically substantiated answers to these questions are necessary to enable us to defeat the HI Virus as it affects us. It would seem only logical, once the assertion was made that ours is a unique HI Virus, that, consequently, unique solutions have to be found to respond to this distinct situation.
Up to now, no answers have been provided to any of the questions that have been posed. Instead, in the name of science and friendship with the Africans, the omnipotent apparatus of which Marcuse wrote, has sought to present honest questions as a manifestation of unacceptable non-conformity.
It has done everything it could, and continues to act, to punish those who dare to ask questions. It uses its might, sustained by the self-repression of the Africans, to ensure the permanent repression of those who inquire.
In 1995 three scientists, Zvi Bentwich, Alexander Kalinkovich & Ziva Weisman, sought to provide answers to some of these questions in a 'Viewpoint' published in "Immunology Today" (Vol 16 No 4). They wrote:
   "Several features of the AIDS epidemic in Africa mark it as a distinct entity from the disease that is present in North America and Europe: it is primarily a heterosexually transmitted disease with a male-to-female ratio of 1:1, and lacks the known 'classical' risk groups of male homosexuals and intravenous (i.v.) drug users; it is probably transmitted more easily; the progression of infection and disease is faster – the time from infection to onset of clinical manifestations and overall survival may be shorter; and the clinical manifestations are different, particularly the main opportunistic infections and the main organ systems involved...
   "Our view is that profound changes in the host immune response may account for the dramatic differences in the behaviour of the AIDS epidemic in Africa and in other developing countries. Such changes make the host more susceptible to HIV infection and less capable of controlling the infection once it is acquired. Infectious diseases, mostly helminth (intestinal worm) infections endemic in Africa and the developing countries, activate the immune system and alter its balance in such a way that makes the host more receptive to HIV and more vulnerable to its effects. This altered 'background' immune response must be taken into consideration when designing vaccines and devising new therapies for HIV in Africa and other developing countries. (Our emphasis).
   "The average African host is exposed to a huge number of infectious diseases from early childhood onwards. These include various bacterial, viral and parasitic infections. Noteworthy is the wide prevalence of helminth infections, malaria and tuberculosis in most parts of Africa: especially in Sub-Saharan Africa, and in East and West Africa. Also of central importance is the very high prevalence of STDs, particularly genital ulcer diseases (GUDs), which play an important role in facilitating the dissemination of HIV infection into the general population... (Our emphasis).
   "In addition to the central role of STDs, important cofactors such as the cultural habit of scarification, as well as transfusion, hygiene and nutrition, may facilitate HIV transmission and infection."
On February 27, 2002, the British newspaper "The Guardian" carried two articles, one entitled: "Sex diseases soar among generation no longer in fear of AIDS epidemic", and the other: "Scourge of syphilis returns as gays fail to heed safe sex message".
The latter article on syphilis says:
   "Within the past year there have been outbreaks of syphilis in Manchester, North London and Brighton. The disease, which had almost disappeared from Britain, can lead to brain damage, disability and even death if untreated...
   "Around three quarters of the Manchester cases have been in young gay or bisexual men, typically in their twenties or early thirties. The heterosexual cases were thought to be a separate cluster with links abroad. About a quarter had another sexually transmitted infection as well as syphilis and around a fifth knew they were HIV positive...
   "A Manchester health authority report said the men told of heavy use of alcohol, and drugs 'with aphrodisiac and disinhibitory effects'... Further research is needed into why people seem not to be heeding safer sex advice, particularly in relation to unprotected anal sex. Reasons could include boredom with the messages, people feeling (inaccurately) that HIV is curable... "
The other article says:
   "Sexually transmitted diseases are rampaging through the UK unchecked as a new generation of young people, who missed the AIDS scare of the 1980s, fail to protect themselves by practising safe sex.
   "According to a report published yesterday by the British Medical Association, (BMA), sexually transmitted infections, which include HIV/AIDS, gonorrhoea and syphilis, have soared by almost 300, 000 cases between 1995 and 2000. The consequences can be devastating. Those who become HIV positive may not die but are condemned to a lifetime on toxic drugs, while thousands of women who unknowingly contract chlamydia, which often has no symptoms, risk infertility...
   "Says the BMA, the group most at risk now – aged 18-24 – are too young to have seen the (1980s AIDS) adverts or been impressed by (their) dire message...
   "Paul Martin, sexual health programme manager in Brighton, where gay men have been encouraged to go for six monthly sexual health 'MOTs' because of an outbreak of syphilis, said their clinics were now 'bursting at the seams'."
"The Daily Telegraph" also of February 27, 2002 reported that:
   "From 1995 to 2000 the figures for new cases (of) gonorrhoea were up by 102 per cent... , chlamydia up by 107 per cent... , and syphilis up by 145 per cent... Thousands of cases of at least 22 other sexually transmitted infections provide the new total.
   "Dr James Bingham, consultant in genito-urinary medicine at Guy's and St Thomas' Hospitals in London, said syphilis was reaching the level seen when Second World War troops came home and gonorrhoea was at levels seen before the AIDS campaigns."
The same edition of "The Daily Telegraph" carries a letter by Robert Whelan of "Civitas" which comments on the BMA report. It is entitled "The results of AIDS scaremongering". The letter says:
   "The spread of STDs, which is particularly concentrated among teenagers and the early twenties, can truly be described as having reached epidemic proportions, and the consequences of some of these conditions can be both serious and long lasting.
   "However, the false sense of security that young people have about STDs is partly due to the hysterical promotion of AIDS as a major public health issue in the late 1980s and early 1990s. The AIDS "epidemic" never materialised and, partly as a result, people now treat all warnings about the consequences of sexual activity as scaremongering. (Our emphasis.)
   "The question is: what do we do about it now? Unfortunately, the leaders of the medical profession appear to have few ideas."
The issues raised by Robert Whelan apply directly and immediately to us. We are the latest victim of the scare mongering that visited the people of the US, the UK and the rest of the western world "in the late 1980s and early 1990s." We too are already harvesting the bitter fruits of the sustained campaign of which Robert Whelan complains.
Had he spoken out against this scare mongering in the 1980s and 1990s, Robert Whelan would have been denounced by the omnipotent apparatus as engaging in a "denial" that would condemn millions of Britons to death.
But, as in the UK, it is precisely this scare mongering that is condemning millions of our own people to ill-health, disability and death because of a refusal to recognise the critical importance of the diseases of poverty and other illnesses that afflict our people, including STDs. This is done to sustain a massive political-commercial campaign to promote anti-retroviral drugs.
The British Medical Association was reporting on the situation in the UK as at year 2000. We are talking here of a country that has a very well developed health infrastructure and a population that is not generally affected by diseases of poverty or exceedingly low levels of education.
The article we quoted earlier, published in 1995 by "Immunology Today" and written by Zvi Bentwich et al, which pointed to "the central role" of sexually transmitted diseases in contributing to immune deficiency, referred especially to Africa and the rest of the developing world.
In that case we were talking of countries that have a very weak health infrastructure, endemic diseases of poverty and widespread ignorance, which results in many taboos and superstitions. If it can be said now of a country as developed as the UK, that a crisis of STDs is emerging, we can only imagine what is happening in the countries of which Bentwich wrote!
Research from the MRC Maternal and Perinatal Research Unit at Kalafong Hospital in Tshwane indicates that between 2,8% and 11% of stillbirths and perinatal deaths were attributed to syphilis in 1993. (Delport, De Jong, Pattinson & Odendaal).
Since then, the prevalence of active syphilis infection in mothers in antenatal care has been reduced by more than half. This success is due to improved primary health care, antenatal care, supply of penicillin, etc.
It is estimated that a 20% reduction in STD's in South Africa over the next 15 years would result in HIV sero prevalence of below 1% in 2015 rather than the projected 16% (Wasserheit 1992). There are 11 million episodes of STD's being treated annually in South Africa, often unsatisfactorily (Reddy, 1999), with 12% of men report symptoms suggestive of STI in the previous 12 months. (South African Demographic Health Survey, 2000).
Because of these prevalence levels, our government is paying particular attention to the prevention and treatment of STD's. For the reasons we have already stated, this will make an important contribution to the fight against acquired immune deficiency.
But for the omnipotent apparatus the most important thing is the marketing of the anti-retroviral drugs. The issues raised by Bentwich and others, of the importance of STDs with regard to immune deficiency have been buried by the imposition of a blanket silence about the incidence and prevalence of these diseases. At the same time, it is demanded of all of us that we must break the silence!
Hopefully, the report of the British Medical Association will become better known to alert even us, who, as Marcuse said, may be suffering from the self-repression of the repressed individual. We should be alerted to the fact that if STDs in a country as developed as the UK are "rampaging through the (country) unchecked", then the situation in our countries must be catastrophic.
Two or three years ago, the South African Medical Research Council (MRC) prepared a report for Eskom on "the incidence of HIV" among the staff of the company. In this report the MRC drew attention to two disturbing matters.
One of these was the high incidence of STDs among our people, as noted by Bentwich et al. The second was the very shoddy medical treatment of these diseases by general practitioners in our country, which leaves many infected people continuing to incubate these diseases because of incomplete and incompetent treatment by our doctors. The article by Bentwich et al draws attention to the serious threat this poses with regard to our immune systems.
Devoted as it is to the propagation of the faith about HIV/AIDS and the marketing of anti-retroviral drugs, the MRC - a state institution supposedly dedicated to serve the people of South Africa – says virtually nothing in its public communications about STDs in our country and what we should do about them.
We know why the pharmaceutical companies pay little attention to the overwhelming majority of diseases that afflict the poor. The simple reason is that the treatment of these diseases does not offer big profits.
The public servants working at the MRC have still to explain why they seem so little interested in the overwhelming majority of diseases that afflict the poor. Could it be the same reasons as those influencing the behaviour of the commercial enterprises!
In a year 2000 letter to a WHO Task Force on STDs, Dr John B. Scythes of Canada wrote:
   "Our basic concept is that by stopping syphilis, or at least slowing it down, far fewer people will get HIV-infected and/or develop AIDS – but not just because of fewer opportunities for transmission of the virus. I respectfully suggest that syphilis represents more than simply an ulcerative or focal activation phenomenon in HIV acquisition/AIDS. Syphilis may also turn out to be an important immunologic co-factor for susceptibility to active viral expression and progression to AIDS...
    "I am suggesting you consider the problem of latent syphilis, when the disease has gone untreated or inadequately treated for some highly variable period of time, a phenomenon which has simply not been investigated in modern times in terms of its immunologic consequences." (Our emphasis).

## Chapter III

Other scientists have also addressed the issues raised above, that "profound changes in the host immune response may account for the dramatic differences in the behaviour of the AIDS epidemic in Africa and in other developing countries."
In an article in the World Journal of Microbiology & Biotechnology 11, 135-143, E. Papadopulos-Eleopolus et al, wrote:
   "AIDS researchers in Africa, including those from the CDC and WHO, admit that immune deficiency in Africa has existed for a considerable period of time and this has not been due to HIV.
   "'Tuberculosis, protein calorie malnutrition, and various parasitic diseases can all be associated with depression of cellular immunity'
(Pearce, R.B. 1986 Heterosexual transmission of AIDS. Journal of the American Medical Association 256, 590-591. Piot, P. et al.)'
   "'A wide range of prevalent (in Africa) protozoal and helminthic infections have been reported to induce immunodeficiency.
(Clumeck, N. et al: Journal of the American Medical Association 254; New England Journal of Medicine 310.'
   "'Among healthy Africans resident in a non-AIDS area, the numbers of helper and suppressor lymphocytes were the same in HTLV-III/LAV seropositive and seronegative subjects...
(Biggar, R.J. et al: The Lancet II, 520-523.)'
   "'Africans are frequently exposed, due to hygienic conditions and other factors, to a wide variety of viruses, including CMV, EBV, hepatitis B virus, and HSV, all of which are known to modulate the immune system... Furthermore, the Africans in the present study are at an additional risk for immunologic alterations since they are frequently afflicted with a wide variety of diseases, such as malaria, trypanosomiasis, and filariasis, that are also known to have a major effect on the immune system... (CMV=cytomegalovirus; EBV=Epstein-Barr virus; HSV=herpes simplex virus). (Quinn, T.C. et al: Journal of the American Medical Association, 257, 2617-2621.)'"
When "The New Encyclopaedia Britannica" (15th Edition), discusses "immune deficiencies" it says:
   "There are several ways in which the protective mechanisms (of the immune system) outlined above may fail. Some are inborn, due to genetic defects in the development of one or more of the cells involved in immune responses. Others result from infectious agents that damage essential immune cells. Still others are due to poisons or to drugs administered accidentally or with the intention of curing or ameliorating other diseases. In yet other cases, the immune deficiency stems from inadequate nutrition...
   "Severe infections by certain parasites, such as trypanosomes, also cause immune deficiency, as do forms of cancer, but it is uncertain how this comes about...
   "In countries where the diet, especially that of growing children is grossly inadequate in respect to protein intake, severe malnutrition ranks as an important cause of immune deficiency. Antibody responses and cell-mediated immunity are seriously impaired, probably due to atrophy of the thymus and the consequent deficiency of helper T cells. This renders the children particularly susceptible to measles and diarrheal diseases. Fortunately, they thymus and the rest of the immune system can recover completely if adequate nutrition is restored."
In its discussion of "sleeping sickness", "The Oxford English Dictionary", Second Edition, says:
   "Any of several similar diseases caused by protozoans of the genus Trypanosoma and transmitted by flies of the genus Glossina, prevalent in tropical Africa, and characterised by the proliferation of the trypanosomes in the blood and changes in the central nervous system leading to apathy, coma, and death."
(We have inserted this definition to explain to the reader some of the diseases caused by the trypanosomes referred to in the medical texts.)
Pacifici et al describe the effects of 100mg of the "recreational" drug Ecstacy used by young people at "rave parties". The 17 volunteers received one or two doses in a 24 hour period, resulting in a 30% decline in blood concentration of CD4+ cells within hours of the single dose. The CD4+ levels recovered to their former levels within the subsequent 24 hours.
Among subjects who received two doses of the drug four hours apart, the decline of CD4+ cells was even more serious, reaching a level of 40% below normal. Although a day later T cell levels rose, they did not return to normal.
(Pacifici R, et al: "Effects of repeated doses of MDMA ('Ecstacy') on cell-mediated immune response in humans". Life Sciences 2001; 69: 2 931 – 2 941.)
Furthermore, the report claims that the effect of Ecstasy can rise to deadly levels among people living with AIDS who take protease inhibitors and non-nucleoside reverse transcriptase inhibitors such as nevirapine.
In another study, Pacifici et al report on the effect on the immune system of the combination of Ecstacy and alcohol, for which they used six healthy volunteers.
There was a decline in CD4/CD8 cell ratio due to a decrease in both percentage and absolute terms of CD4 T-helper cells and a simultaneous increase in natural killer cells. Alcohol consumption produced a decrease in T-helper cells and B lymphocytes. The combination of MDMA and alcohol (ethanol) had the greatest suppressive effect on T cells. Drug treatment also produced also produced a large increase of immunosuppressive cytokines.
(Pacifici R, et al: "Acute effects of 3,4 methylendioxymethamphetamine alone and in combination with ethanol on the immune system in humans". J Pharmacol Exp Ther, 2001; 296(1): 207-215.)
Put simply, what all this means is that the drug Ecstacy on its own and in combination with alcohol suppresses the immune system. It is not difficult to see from this that, as with intravenous drug users, prolonged abuse of this drug alone and together with alcohol, can lead to acquired immune deficiency. This has nothing to do with HIV!
All the scientific texts we have cited assert that there are many conditions that cause changes to the immune system, including malnutrition and various tropical diseases, themselves a manifestation and consequence of poverty and underdevelopment. To our knowledge, no serious scientist has or would question these known and provable scientific truths.
Unfortunately for us, and the scientists, the omnipotent apparatus denounces these views as being non-conformist and therefore totally unacceptable. It condemns them as belonging to a school of thought categorised as "dissident" and genocidal. They must therefore be suppressed.
This must be done, so they say, to save us, the Africans, from the HIV/AIDS pandemic and, according to them, the sole cause of immune deficiency, HIV.
Honest medical science recognises the disastrous impact of malnutrition on us as Africans and the rest of the developing countries.
An Indian article (aidscareindia.com) says: (See also: the World Health Report, 1998):
   "Some 40% of the 10 million deaths among under-five children each year in the developing world are associated with malnutrition...
   "Maternal malnutrition is the major determinant of IUGR (intrautrine growth retardation) in developing countries...
   "In Africa... the actual number of malnourished children has, in fact, risen. In addition, natural disasters, wars, civil disturbances, and population displacement have all contributed to continuing high rates of malnutrition...
   "Iodine deficiency disorders (IDD) constitute the single greatest cause of preventable brain damage in the fetus and infant, and of retarded psychomotor development in young children. It remains a major threat to the health and development of populations the world over, but particularly among preschool children and pregnant women in low-income countries...
   "Vitamin A deficiency (VAD) is a major public health problem, and again the most vulnerable are preschool children and pregnant women in low-income countries. In children, VAD is the leading cause of preventable visual impairment and blindness... In addition, VAD significantly increases the risk of severe illness and death from common child infections, particularly diarrhoeal diseases and measles... In VAD-prevalent countries, pregnant women often experience deficiency symptoms, such as night blindness, that continue into the early period of lactation...
   "Iron deficiency is the world's most widespread nutritional disorder, affecting both industrialised and developing countries. In the former, iron deficiency is the main cause of anaemia. In developing countries, it is also associated with other nutrient deficiencies (folic acid, vitamin A, B12), malaria, intestinal parasitic infestations (especially hookworm, schistosomiasis and amoebiasis), and chronic infections such as HIV...
   "Zinc deficiency causes growth retardation or failure, diarrhoea, immune deficiencies, skin and eye lesions, delayed sexual maturation, night blindness and behavioural changes...
   "Inadequate dietary calcium intake is associated with a number of common, chronic medical disorders worldwide, including osteoporosis, osteoarthritis, cardiovascular disease (hypertension and stroke), diabetes, dyslipidaemias, hypertensive disorders of pregnancy, obesity, and cancer of the colon...
   "Outbreaks of beriberi, pellagra and scurvy still occur among the extremely poor and underprivileged and, not infrequently, in large refugee populations...
   "Between 30% and 40% of all cases of cancer are preventable by feasible and appropriate diets, physical activity and maintenance of appropriate body weight."
The same applies to heart disease and stroke, which accounted for 22% of deaths in South Africa in 1996.
One third of the annual 55.7 million deaths in 2001 globally, were caused by heart disease and stroke, with the majority occurring in developing countries. This is a true "pandemic", propagated by the 'globalisation' of risk factors such as cigarette smoking, salty high saturated fat foods, obesity and lack of exercise.
(NB: in many parts of our country, our soil suffers from zinc deficiency. This affects the plants grown in such soils, which are part of the national food supply. In addition, the staple maize meal consumed by the majority of our people comes out of the milling process completely denuded of its nutritional value. Nevertheless, because the religious faith demanded of us prescribes that we attribute all ill health to the HI Virus, it is prohibited that any of the foregoing should either be known or discussed. Any discussion focused on eliminating the zinc deficiency mentioned above falls victim to the accusation of 'fiddling while Rome burns.' Terrified of bad publicity, and keen to demonstrate that we are not fiddlers, energetically and with smiles on our faces, we fan and feed the fires that are consuming Rome!)
A US-trained physician from Haiti, Paul Farmer, has written in his book "AIDS and Accusation": (University of California Press, 1993):
   "Although repeatedly termed a 'complete mystery' by North American academics, the epidemiology of AIDS and its silently transmitted precursor, HIV, is only superficially random. Careful review of existing data and critical assessment of the validity of certain studies allow us to conclude that the Haitian epidemic is a tragic but unsurprising component of a much larger pandemic. In the various theaters of this international scourge, whether New York or Port-au-Prince, HIV has become what Sabatier (1988) has termed a 'misery-seeking missile'. It has spread along the path of least resistance, rapidly becoming a disorder disproportionately striking the poor and vulnerable... AIDS is far more likely to join a host of other sexually transmitted diseases – including gonorrhea, syphilis, genital herpes, chlamydia, hepatitis B, lymphogranuloma venereum, and even cervical cancer – that have already become entrenched among the poor." (Our emphases.)
Not surprisingly, "the Harvard University Gazette" of March 19, 1998 carried an article entitled – "AIDS Epidemic Called Crisis Among Blacks". The article, written by William J. Cromie said:
"Once considered a white epidemic in the United States, AIDS has now changed colour.
"From 1985 until 1996, whites accounted for the highest percentage of AIDS infections, but the line was crossed in 1996. Cases among whites dropped from 60 percent of the total in 1985 to about 35 percent in 1997. Among blacks, cases have almost doubled, from about 25 percent to 45 percent, in the same period...
"Henry Louis Gates Jr... summed up the situation this way: 'While blacks make up only 12 percent of the U.S. population they account for almost half of the cases of AIDS'...
"The numbers are especially bleak for black women and children... Black women represent the highest percentage (56 percent) of all AIDS cases reported among women, and an increasing proportion of new cases (60 percent). Fifty-five percent of new infections with the AIDS virus among 20 to 24-year-olds occurs among blacks.
"Among those between the ages of 24 and 44 years, three times as many black as white men died of AIDS in 1996. Five young black women died for every white woman in the same year...
"The CDC also reported that black children currently account for 58 percent of the AIDS cases among newborns, compared to 18 percent for whites, and 23 percent for Hispanics.
"Most women, black and white, have contracted AIDS either through illegal drug use (about 45 percent) or heterosexual contact (about 38 percent). Many of the latter cases are due to having sex with men who have gotten the disease from contaminated needles.
"CDC statistics show that 22 percent of all AIDS infections among men were caused by dirty needles. Black males account for 36 percent of such cases...
"One in every two blacks has been tested for infection with HIV – the AIDS virus – compared with 38 percent of all Americans. Among blacks younger than 30 years the testing rate is 65 percent. Most of the testing was done during the past 12 to 18 months."
As Dr Farmer of Haiti had said, five years before the Harvard article appeared, whether in New York or Port-au-Prince, HIV has spread along the path of least resistance, rapidly becoming a disorder disproportionately striking the poor and vulnerable.
All of this tells us, the Africans, that poverty and underdevelopment are a major cause of premature mortality and disability among us. We are confronted by 'the larger pandemic' of poverty and underdevelopment. But the omnipotent apparatus is intent that we should not know all this. If we do, we should discount it as being of no major consequence.
And yet there is a large volume of literature that addresses the critically important issue of health, poverty and underdevelopment, some of which we will now proceed to cite.
The "African Institute for Scientific Research and Development" has written:
   "In rural Africa agriculture, health and the environment are like three sides of a triangle. As the sides define and determine the triangle, so do agriculture, health and the environment both define and determine rural development. For socio-economic development to occur attention must be paid to all the three aspects...
   "Despite national and international efforts to improve health for all, many communities in East Africa are still plagued with communicable and other preventable diseases such as tuberculosis, immunisable childhood diseases, nutritional disorders, maternal deaths, eye infections, injuries, and problems related to alcohol and narcotic drug abuse.
   "Common infections such as acute respiratory tract infections, diarrhoea, malaria and sexually transmitted diseases (including HIV/AIDS) are responsible for most of the morbidity and mortality in rural communities. The incidence of many of these diseases can be drastically reduced through community based health education, immunization, improved mother and child health care and enhanced nutrition."
The University of Glasgow Department of General Practice, International primary health care, has published the following article:
"Health in Zambia and the UN AIDS Conference in Lusaka"
Dr DOROTHY LOGIE, GP Adviser to Borders Health Board (Report on a meeting held on 09/02/00) in which she writes:
"At a recent conference in Lusaka the staggering proportions of the AIDS epidemic in Sub-Saharan Africa was thrown into relief. With 10% of the world's population and two thirds of the world's cases of HIV, the burden of what is arguably the worst epidemic to hit mankind since the 'black death' has fallen primarily on the world's poorest nations.
"With Zambia as an example, Dr Logie set the HIV epidemic in its context. The fall in life expectancy to 43 years has not only followed on from an ever increasing incidence of HIV but has been in the context of a 30% cut in spending on education and a 50% cut in spending on health. In a country which 20 years ago had a well developed schooling and health care service, diseases of poverty such as TB, waterborne diseases and malaria are on the increase, as are maternal and infant mortality indicators. One quarter of children are undernourished and one half of the country has no access to safe water. Three quarters of girls and a half of all children do not now complete primary education. Four fifths of the population live on less than 60p a day.
"Zambia owes the rest of the world, primarily the World Bank and the IMF, $6.5 Billion, more than twice the country's gross national product. The debt must be serviced at $200 million per annum, regardless of the cost to health, education or nutrition. This amounts to one half of all export earnings. Seven times as much is spent on servicing its debt as it can afford to spend on health care. The cuts in education and health care spending have been driven by structural re-adjustments demanded by the World Bank. These have included introducing user fees for health and education and placing a limit on state responsibilities. (see Table 1)...
"There is urgent need for action to challenge the selective blindness of a global economic system incapable of taking the radical steps necessary to provide stability and hope in an entire continent facing a bleak future. The positive first steps of the British government to cancel the debts of the world's 25 poorest countries, albeit with heavy pre-conditions, are to be supported and more drastic steps urged. As health professionals we have a duty to research and highlight the damaging impact on health of imposed Western economic re-adjustments and to unequivocally condemn the intolerable burden of unsustainable debt."
For its part, the "African Journal of Food and Nutritional Sciences", Volume 1 No. 1 August 2001, Abstracts, published the article:
CO-EXISTENCE OF OVER- AND UNDERNUTRITION RELATED DISEASES IN LOW INCOME, HIGH-BURDEN COUNTRIES: A contribution towards the 17th IUNS congress of nutrition, Vienna, Austria 2001
Rutengwe R., Oldewage-Theron W, Oniang'o R & Vorster H.H.
Abstract
   "About one third of the world's population suffer from micronutrient deficiencies and hundreds of millions suffer from chronic diseases of lifestyle. Prevalence rates, particularly low birth weight, stunting and underweight, remain high particularly in Eastern Africa and South Central Asia. More than a third of all children in developing countries remain constrained in their physical growth and cognitive development. The 1990 ambitious goal of halving childhood underweight prevalence by the year 2000 has not been achieved by most countries. Global progress in fighting malnutrition is slow and crippled by rapid increase of both communicable and non-communicable diseases, the so-called "double burden of disease". About 115 million people suffered from obesity related diseases in the year 2000. Overweight and obesity (globesity) prevalence is advancing rapidly in developing countries.
   "Cardiovascular diseases (CVD), myocardial infarction, angina pectoris and stroke as one of the most important causes of mortality and morbidity globally, will continue to be first and second leading causes of death in the world. Most developing countries, including South Africa, currently are in the process of transition and experiencing the double burden of both communicable and non-communicable diseases in which chronic diseases of lifestyle such as CVD have emerged while the battle against infectious diseases has not been won. In the last few years the HIV/AIDS epidemic has spread extremely rapidly and is likely to double overall mortality rates, undermine child survival and halve the life expectancy over the next five years." (Our emphases).
The US Environmental Research Foundation published an article on February 5, 1998, entitled:
"Poverty Makes You Sick"
"Numerous studies in England and the U.S. have shown consistently that a person's place in the social order strongly affects health and longevity. It now seems well-established that poverty and social rank are the most important factors determining health – more important even than smoking...
"George Kaplan and his colleagues at the University of California at Berkeley measured inequality in the 50 (US) states as the percentage of total household income received by the less well of 50% of households. (British Medical Journal, Vol 312, April 20, 1996: 999-1003.) It ranged from 17% in Louisiana and Mississippi to 23% in Utah and New Hampshire. In other words, by this measure, Utah and New Hampshire have the most EQUAL distribution of income, while Louisiana and Mississippi have the most UNEQUAL distribution of income.
"This measure of income inequality was then compared to the age-adjusted death rate for all causes of death, and a pattern emerged: the more unequal the distribution of income, the greater the death rate. For example in Louisiana and Mississippi the age-adjusted death rate is about 960 per 100,000 people, while in New Hampshire it is about 780 per 100,000 and in Utah it is about 710 per 100,000 people. Adjusting these results for average income in each state did not change the picture: in other words, it is the gap between rich and poor within each state, and not the average income of each state, that best predicts the death rate...
"Isn't it time that the public health community – physicians, public health specialists, and environmentalists – recognised that poverty, inequality and racism cause sickness and death? Given what science now tells us, medical policy – including medical training – should aim to combat and eliminate poverty, inequality, and racism just as it now aims to combat and eliminate infectious diseases and cancer. With U.S. health care costs now exceeding $1 trillion each year, anti-poverty and anti-racism initiatives would be economically efficient as well as humane." (Our emphasis).
A British medical journal aimed at medical students, Student BMJ Vol 9, June 2001, published:
"Poverty and Health" by Mike Rowson in which he says:
" Poverty is the number one killer in the world today, outranking smoking as the leading cause of death... (Our emphasis).
"Health professionals need to promote interdepartmental cooperation and action by governments to promote better education, water, and sanitation and other services which improve the lives of the poor. The diseases of poverty cannot be tackled without concerted economic and political action."
The series, Current Infectious Disease Reports 3:1-3, 2001, published an article:
"The Unacceptable Costs of the Diseases of Poverty" by Richard L. Guerrant, M.D., University of Virginia School of Medicine, USA, in which he writes:
"Poverty and lack of sanitation result in high-risk behaviours and malabsorption-inducing enteric infections. Thus the complex interactions of such societal issues as poverty and lack of basic sanitation in areas where only suboptimal therapeutic regimens are affordable may drive the resistant microbes that threaten us all...
"The most important medical/health advance of our century will be the discovery and realisation of the true costs of the diseases of poverty... (Guerrant's emphasis.)
"The lessons of tropical and resistant infectious diseases are that only with a recognition of their root causes linked to poverty will we apply readily available technologies and develop new tools for their control. Only this recognition will determine whether we shall or shall not chart a secure future for ourselves and those who follow."
The campaign US "World Hunger Year" said:
"In the last 50 years, almost 400 million people worldwide have died from hunger, hunger-related diseases and poor sanitation. That's three times the number of people killed in all wars fought in the entire 20th century. (Above information provided by Bread for the World Institute)...
"Each day in the developing world, 30, 500 children die from preventable diseases such as diarrhoea, acute respiratory infections or malaria. Malnutrition is associated with over half of those deaths. (Above information provided by UNICEF, World Health Organisation)."
Naturally, the story is the same with regard to specific instances. On July 24, 2000, Johns Hopkins University issued the following statement:
"The Bill & Melinda Gates Foundation has awarded the Johns Hopkins School of Public Health $20 million to find the precise combination of vitamins and other micronutrients that will be most effectively save lives and prevent illness among impoverished mothers and children in the developing world...
"'The results of these studies are likely to prove crucial to the well-being and survival of millions of women and children a year,' said William R. Brodie, president of the Johns Hopkins University...
"In the developing world, an estimated one in four children dies before reaching age 5. Worldwide, some 11 million children and 7 million adults die each year from diseases associated with poverty."
The Hookworm Vaccine Initiative reports:
"Hookworm infection is one of the most prevalent and devastating infections of humans - more than one billion individuals harbor hookworms in their intestine (1,2). Some tropical clinical investigators rank hookworm as the second most important parasitic infection of humans, next to malaria (3). Within developing economies hookworm is a leading cause of anemia and malnutrition. In China reliable estimates based on diagnostic testing of almost 1.5 million individuals indicate that 194 million individuals harbor hookworms (4,5), making hookworm one of China's most significant public health problems. Similar numbers of cases of hookworm occur on the Indian subcontinent, in Sub-Saharan Africa (6), and in Central and South America (7) (Fig. 1).
"The World Bank estimates that more than 20% of the disability-adjusted life years (DALYs) lost from communicable diseases among children living in developing economies are a direct result of intestinal nematode infections like hookworm (9). In its 1993 World Development Report, the World Bank ranked intestinal helminths first as the main cause of disease burden in children aged 5 to 14 years.
"Estimates of hookworm infection in pregnancy conducted jointly by the Wellcome Centre for the Epidemiology of Infectious Diseases (Oxford University) and the WHO indicate that some 44 million women are simultaneously pregnant and infected with hookworm (10). An estimated 3-5 million of these pregnant women harbor heavy hookworm infections that adversely influence intrauterine growth rates, prematurity and birth weight.
"Overall, hookworms are central to the downward spiral of malnutrition and rural poverty in less developed countries. Recently, hookworm has also been identified in some populations as an important medical problem among the elderly living in poor rural areas (11).
"In this decade, new information has reawakened the international community to the importance of hookworm-associated chronic blood loss and the resulting protein malnutrition, negative nitrogen balance, iron deficiency and anemia. These features have again been linked to devastating consequences for both children and mothers (8-10,15-20). It is now well recognized that moderate and heavy hookworm infections during childhood cause stunting of linear growth, reduced physical fitness and physical activity, as well as intellectual and cognitive retardation in children (15,17-21).
"Many of these clinical features are directly attributable to the chronic effects of iron deficiency (22-24); in some instances these deficits are irreversible (24). Plasma protein losses also contribute to hookworm-associated malnutrition. As a consequence, children are also rendered susceptible to intercurrent viral and bacterial infections (15). Chronic hookworm infection prevents children from achieving their full potential to become productive individuals in later life. During pregnancy more than 10 percent of hookworm-infected women suffer worm burdens heavy enough to adversely affect intrauterine growth, prematurity, and birthweight (10).
"Together, these consequences devastate maternal and child health. When accurately accounted for, such as in the World Bank study mentioned above, these features place hookworm infection at the top of the list in terms of their impact on childhood and maternal health."
Global estimates of hookworm prevalence by region (1).
| Region | Population | Hookworm Infections | %Prevalence |
| Sub-Saharan Africa | 512 million | 140 million | 27% |
| Latin America | 441 million | 135 million | 31% |
| Middle East | 503 million | 96 million | 19% |
| India | 850 million | 319 million | 38% |
| China | 1160 million | 358 million | 31% |
| Other Asia/Islands | 654 million | 250 million | 38% |
| Total | 4120 million | 1297 million | 31% |