The contest between a clever virus and a facultatively clever host
Authors: I. Loefler
Journal: Journal of the Royal Society of Medicine (2002)

The world’s attitude to the African HIV pandemic is scandalous. The task of dealing with it is judged hopelessly difficult. Yet this pandemic is not only an African disaster; it could affect a large part of the world’s population; it threatens world peace and development; it could set back the human species more than the black death damaged medieval Europe. The stance of western governments is generating an ever-growing moral outrage but unfortunately this centres on a demand that HIV carriers and AIDS victims be given antiretroviral medication. Many people in Africa and the world at large are under the impression that, if we supplied the 40 million with antiretroviral drugs, if we made sure that HIV-positive pregnant women were treated so that their offspring do not become infected, and if we reared the AIDS orphans, justice would have been done to Africa. Virchow, in the 19th century, recognized that epidemics represent biological phenomena as well as social pathology. To understand the African HIV pandemic one has to grasp the environmental and the social changes that took place in Africa in the last 150 years. The colonization of Africa brought rapid and immense social and technological change which in turn had enormous impact on the environment. By the middle third of the 20th century this impact was felt in every corner of the continent and the last bastions of the old African environment began to fall. The great clearing of the forests was in progress. The retreat of the forests deprived countless species of their habitats. As the species dwindled, with them vanished the microhabitats in which specific organisms lived. Some of these organisms, in their search for a new host, did not need much ingenuity: their vectors carried them onto a new and increasingly abundant host—Homo. Similarly sometime in the middle third of the 20th century, a peculiar retrovirus, independent of a vector, took the opportunity to leap the species barrier from the vanishing species of primates into man. This leap across a species barrier necessitated considerable adaptation and after a series of mutations a new species of microorganism evolved—the human immunodeficiency virus. Whilst the ancestral virus spread by being walked or jumped from tree to tree, the host of the newly evolved species, just about the time of the evolutionary leap, had begun to move about by train, steamboat, bus and, latterly, the wide-bodied jet. Many of the mass movements of the host, particularly those in the postcolonial era, have been displacements occasioned by the intrusion of armed hordes of the male now airlifted from one corner of the continent to the other. As the virus is transmitted by intimate blood contact, sexual transmission is the rule. The Africans, broken by colonization, live in dysfunctional polities. The social pathology of the postcolonial era is the joint responsibility of the colonizer who walked away, the parasitic African oligarchies and the world economic and ideological environment. The outstanding characteristic of misdevelopment is the extremely unfavourable income distribution: the upper class, amounting to less than 5% of the population, commands more than half of the national incomes. With regard to HIV, four glaring examples of social pathology deserve special mention. The first is superstition and the proclivity to believe in all manner of hearsay, be it that AIDS is spread by deliberately infected condoms, that defloration of a virgin brings cure, that AIDS has nothing to do with a virus and so forth. The second is denial. The connotations of homosexuality and apes amplified the abhorrence of acknowledging a sexually transmitted disease. Society, led by the churches and governments, denied first the very existence of the epidemic, later its magnitude, then its causation. Because of this denial nothing was done to limit the spread. The third is religious influence. The Catholic Church, and to a lesser extent the Islamic clergy, bear responsibility for an undetermined but sizeable proportion of the pandemic. The clergy did not confine itself to condemning condoms on the customary ground that by preventing conception they deprive intercourse of its primary purpose; the clergy condemned condoms as unreliable and permeable to the virus, and in some instances went so far as to declare that condoms are deliberately contaminated, the intent being to wipe out Africans. (A cardinal and a Muslem religious leader burnt condoms and sex education material in the ‘Freedom’ park of Nairobi.) Not only did the Catholic Church wage a condom war; it also prevented, or at least delayed, the introduction of sex education in schools. The fourth is exceptionalization. Eventually, when denial became impossible, the epidemic was exceptionalized. This was not just another disease: HIV positivity is not a state P E R SO N A L P A P E R