Tanzania, Kagera Region, epicentre of AIDS 15 years ago:

Present situation

By Dr. Marc Deru



In Tanzania, the population of the Kagera region, epicentre of AIDS 15 years ago, hasn’t ceased growing since then, ie with a 53% increase between 1988 and 2002.

The demographic catastrophe expected as a result of the “deadliest epidemic in history” did not materialize, on the contrary. Yet, no real, concrete anti-viral measures were applied in the region. The only explanations for this lie in the improvement in the economic conditions and in development aid. An example of a global approach to development is found in the NGO, Partage Tanzania.

While the experts, with their statistics, would have one believe that there exists an extremely serious HIV/AIDS epidemic, no trace of an epidemic is observable in the field. All that can be seen is a very poor, under-nourished population suffering from malaria, endemic immunodeficiency and common illnesses.

The so-called “HIV” tests are unspecific; the positive results they may give are misleading and lead to the false belief in the existence of a viral epidemic. Common sense and scientific reason dictate their abandonment as well as a return to the objectivity of clinical diagnosis and to the treatment of clinically visible illnesses, all of which have been known for a long time.

The facts very clearly demonstrate that the endemic African imunodeficiency has nothing to do with a hypothetical “HIV”, but is, rather, the result of malnutrition and its corollaries.

In order to provide effective help to Africa, the priority should be given to the eradication of the overly great poverty which exists there.

This past summer, I had the opportunity of spending two and a half months in the Kagera Region of Tanzania. Along with the Rakai district of Uganda, this region was considered, some 15 years ago, as the epicentre of AIDS in Africa.

I was based in town, in Bukoba, but often roamed about in the bush, visiting and sometimes lodging in the 21 villages of the rural district of Bukoba covered by the French NGO, Partage Tanzania, an area with approximately 70,000 inhabitants.

In 1989, Partage Tanzania set up an overall development aid programme, the Victoria Programme, centred on orphans and their families. This programme was initiated at a time when the region was in really dire straits resulting from, among other things, the catastrophic economic situation which prevailed in Tanzania since the end of the seventies and also the war against Idi Amin’s Uganda, which had ravaged the region.

In the 1980s, Bukoba had been a ghost town in which everything was lacking, where matches and soap had to be purchased on the black market… In rural areas, dire poverty, entirely inadequate nutrition, lack of health and medical care and a very high mortality rate prevailed. In the region bordering Uganda, there was a very active smuggled goods market, which was not limited to basic commodities; drugs were in circulation, as was alcohol (of the home-brewed variety, a veritable poison owing to its methanol content), of which the young smugglers were the primary consumers as well as the first victims.

In 1985, the newly out “HIV” tests detected the first HIV-positive individuals in precisely this same border area. In no time, the economic, nutritional and sanitary backwardness came to be considered as constituting a new viral epidemic disease. According to the experts, this Great Lakes region was doomed to be decimated, unless energetic measures were taken to combat this new deadly virus.

Fiteen years later, we can begin to take stock of the situation.

The following are official census results for Tanzania and for the Kagera region.

For Tanzania, a regular upward curve can be observed for the period 1967 to 2002, with a growth of 49% between 1988 and 2002. There is no drop in the population. For the Kagera region, we see the same upward curve, with 53% growth between 1988 and 2002.

See also the two graphs showing birth and death statistics compiled by Partage Tanzania since 1993 with reference to the population of 15 villages in the rural district of Bukoba, which encompasses some 30,000 people.

Note the definite upward trend with respect to births.

Note the downward trend with respect to deaths.

Ten years and 30,000 people is both too short a time and too few numbers to be able to attempt an interpretation of data in demographic terms. I thus present these two graphs only by way of indication. I find them interesting because they illustrate the evolution of a population living at the epicentre of AIDS in the most critical period, ie at a time when the epidemic was expected to decimate the population.

The expected demographic catastrophe thus never occurred, and the supposedly deadliest epidemic in history revealed itself to be singularly mild in its effects.

Did exceptional health measures have been taken in order to prevent the anticipated depopulation?

There have been, and continue to be, advertising campaigns relating to the use of condoms, numerous articles on AIDS in the newspapers, on “HIV” and the threat of an epidemic, as well as lots of words on the subject at meetings and in official speeches. The only example of a concrete health measure taken is the fact that one of the 5 AIDS centres in Tanzania is in the Bukoba regional hospital. The Médecins du Monde NGO is in charge of the testing programme, the follow-up of HIV-positive persons and promoting the use of condoms; since 1998, AZT has been administerd to HIV-positive pregnant women in order to prevent what is called “mother to child transmission”. This action is fairly limited in scope and affects pregnant women who go to the Bukoba hospital.

Outside of Bukoba, in the rural areas of the Kagera region, practically no preventive health or curative anti-viral measures have been applied. The fact that the population has returned to normal life following the disaster of the 1980s can only be attributed to the gradual improvement of the economic situation and to the development aid.

I can tell you especially about the help furnished by Partage Tanzania. Its overall programme encompasses some 300 salaried workers, day centres for orphans, food and health care dispensing centres, kindergartens, domestic and professional training, restoration of homes and croplands, management of safe water supply points, etc.

During the first years, “HIV” tests were conducted, but they led to the observation that sick children, whether “HIV”-positive or “HIV”-negative, recuperated equally well, so long as they received adequate nutrition and medical attention. The tests thus proved to be of no practical benefit and were abandoned, as was the notion of a new epidemic disease. In cases of severe immunodeficiency, patients are treated for opportunistic diseases and for the various infections, types of malaria and digestive problems that can be encountered, and immunity is built up through a balanced diet and vitamin supplements.

The results have been excellent, for instance: among the 4,000-odd orphans taken in charge by Partage Tanzania, the mortality rate is 1/3 of the national infant mortality rate and ¼ of the regional infant mortality rate.

In addition, here are a few personal observations I was able to make during my stay.

*The general health of the Partage Tanzania orphans is very satisfactory.

Photograph of schoolchildren taken during a noon break. Observe that they don’t look too unhappy!

The children are well nourished and their illnesses are generally common in nature. Of these 4,000 children, at least twenty (0.5 to 0.6%) suffer from obvious, chronic immunodeficiency; these children are subject to repeated respiratory, ear, nose and throat, digestive and cutaneous infections and are the object of special attention.

* Outside of the Partage Tanzania centres, I noted that the rural population has a very unbalanced diet. Though sufficient in terms of calories, there are too many starchy foods and not enough foods rich in proteins, vitamins and minerals. These nutritional elements, which are indispensable for growth and proper body function, are usually lacking to a large extent. This led me to an understanding of why the state of health of young children and active young adults is so precarious, and also why women are often so exhausted, from an organic point of view, after several pregnancies and nursing periods.

For the doctors, nurses, social workers and people working or conducting enquiries in the field that I was able to meet and question, it is obvious that the prevailing great poverty and malnutrition are the root causes of all of the health-related problems, including the serious immunodeficiency.

After malnutrition, malaria is the next major problem, being responsible for 1/3 of general mortality and more than 2/3 of mortality among children under five years of age (mostly from cerebral malaria and very serious anemias).

*At the Bukoba hospital, which I was able to visit completely, the only overpopulated ward was that reserved for children: 60 beds for approximately 80 children (the number can reach 150), mostly under five years old and suffering mainly from severe malaria, severe anemia and pneumonia, almost always against a background of malnutrition.

On the other hand, in the tuberculosis and AIDS ward, there is (luckily) no overcrowding. Some of the beds are unoccupied. The attending nurse spontaneously remarked to me that the basic problems of these gravely ill patients result from their very low socioeconomic status, undernourishment and alcoholism.

Thus, for more than 15 years, the various scientific, medical and mass media alike have ceaselessly portrayed Africa as the continent caught in the grip of a new deadly sexually transmitted infection, and doomed to the most sombre future imaginable. Yet, during this very same period, the population that was in the eye of the cyclone and received no specific treatment has continued to increase as before.

The international community has been alerted and mobilized to fight a new and extremely serious viral epidemic, while, in the field, no trace of an epidemic can be found. What one does observe is the presence of a very poor, badly nourished and malaria-ridden population suffering from commonly encountered illnesses, against a background of endemic immunodeficiency.

Where does this discrepancy between the information we are fed and the reality of the situation, between the scientific pronouncements and the facts, come from?

It stems quite simply from the fact that the international experts aren’t observing the same thing as what people in the field are seeing: the former (the experts) are interested in “HIV” test results, that is, in serologically-based epidemiology, whereas the others are concerned with patients and illnesses, that is, with clinical epidemiology, which is not the same thing at all.

The epidemic mentioned in our newspapers is the product of WHO estimates based on the results of antigen-antibody (AG-AB) serological tests, referred to as “HIV” tests.

Now, in Africa, what does it mean to have a positive “HIV” test?

(This is not an appropriate time to go into the fundamental criticism levelled against the test, specifically in connection with the problem of the isolation of the HIV; this point will be dealt with this afternoon.)

Let’s consider only the following well-known scientific fact: owing to cross-reactions, the AG of one test can react with ABs other than those which are specific to it.

AG-AB interaction

(The AGx which caused the appearance of anti-x ABs will react with the latter if a test brings them into contact with one another. The same applies to AGy and anti-y ABs. However, it can happen that AGx will react with anti-y ABs or even other ABs, and vice versa.)

As early as 1985, when “HIV” tests were first used, it was demonstrated that they could give a positive result in, among other circumstances, cases of tuberculosis, leprosy, malaria and some viral diseases, and also after certain types of vaccinations, after blood transfusions, as well as in healthy, multiparous pregnant women.

It so happens that multiparity is the rule in Africa. In Tanzania, for example, the average number of pregnancies is around five. Tuberculosis and other infections are endemic, malaria is omnipresent, etc. One can just imagine the frequency of possible cross-reactions.

Thus, a positive test - and this applies especially to Africa – is not a sign of a specific viral infection. These so-called “HIV” tests are deceptive, in that the positive results give the illusion that a precise diagnosis has been made. These tests are therefore misleading. They are also dangerous because they cause panic and stigmatization, they lead to the use of toxic anti-viral drugs and they draw attention away from the real sources of immune system deficiencies.

And yet, it is these very same misleading results which constitute the basis of official statistics and which lead, first the experts, then the scientists, medical doctors, newspaper reporters, and finally the general public to believe that Africa is being ravaged by a specific viral infection called “HIV/AIDS”! People speak of an epidemic of “HIV/AIDS”, but the only thing which has the appearance of an epidemic is what I would call the “epidemic of tests”, an artificial epidemic which is being actively promoted!

For a person working in the field, there is no “HIV” epidemic; there is the endemic immunodeficiency which has always existed in Africa, with its high points and low points, depending on living conditions and nutritional factors.As a result of catastrophic living conditions, this endemic seriously worsened in the Kagera in the 1980s, so far as to be sometimes lethal and take epidemic appearance, called AIDS epidemic. Today, for nurses and doctors in the field, there are immune system-depressed people suffering from long-established and well known illnesses which are curable through appropriate care.

The conclusions are self-evident.

Pursuing testing is unreasonable and even harmful. It is unjustifiable, on either a scientific or medical basis.

The only reasonable attitude to take is to return to the simplicity and objectivity of clinical practice, to the diagnosis and treatment of clinically visible illnesses.

In case of clinical AIDS, a search for the causes should be carried out for each patient: nutritional deficiencies, infections, every possible intoxications (eg ethanol-methanol intoxication) should be systematically looked for in order to determine with precision and certainty all immunosuppressive factors.

Funds should be awarded for the achievement on a large scale of such clinical studies: it will then be possible to draw reliable scientific conclusions.

The fundamental solution to the problems of endemic immunity in the Kagera region, and also, I believe, in Africa in general, does not lie in medicine. The solution must necessarily involve the elimination of excessive poverty and thus depends on the implementation of new socio-economic measures and on new political choices in which absolute priority is given to the improvement of living conditions.

This represents quite an undertaking for African governments, for the international community in general and for all those concerned about helping Africa.

African populations need safe drinking water and access to basic medical care. They require that effective action be taken against malaria. Above all else, however, they need to become less poor and to be educated, so as to acquire the means of improving their living conditions and their nourishment.

Those are the real priorities.

To state that the priority, with respect to emergency humanitarian aid, should be given to the fight against “HIV” and to giving those countries the possibility of buying cheap-priced anti-viral products is just as irrational as saying to someone suffering from acute vitamin C deficiency, “Sir, I see that you are suffering from scurvy. You’d better go buy yourself some antibiotics and condoms.”

If we are really concerned with the health of the people of Africa, then it is urgent for us to change our tune. Plain common sense, as well as scientific reason, make it imperative that we do so.

Dr. Marc Deru, December 8, 2003, European Parliament, Brussels.

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