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HIV/AIDS: Dangerous Statistics

Is the use of estimates in measuring HIV/AIDS leading to other diseases being wrongly classified?
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Few people realise that the familiar HIV/AIDS global statistics are actually estimates. For example, UNAIDS estimated that South Africa had 140,000 HIV/AIDS deaths in 1997. However, after tabulating all death certificates for 1997, South Africa attributed only 6,635 deaths to HIV/AIDS.

Such discrepancies are rarely noted. The familiar UNAIDS/WHO estimates are widely displayed in slide shows and publications, and echoed on TV and radio. Conversely, national internal surveillance data and death counts do not receive wide distribution. However, the computer models that generate the WHO/UNAIDS estimates incorporate two common misconceptions about the nature of HIV infection. First, they utilise a nine – 11-year survival period for HIV infection, a longevity that corresponds with the respective belief that HIV has an average, 10-year, silent incubation period.

By 1983, even before HIV had been discovered, the Centers for Disease Control (CDC) determined that AIDS had an average incubation period of eight to 18 months, which the CDC determined by actively tracking and interviewing patients. Danish physicians reported similar incubation periods. In addition, there are reports of two-month and six-month incubation periods following homosexual contact, blood transfusion, or IV needle transmission. Reports of these incubation periods were not widely distributed. Rather, the incubation periods imputed into the computer models are mathematical models themselves.

In the US, early in the epidemic, 50% patients died within 12 months of manifesting opportunistic infection. Therefore, among adults, the wave of AIDS deaths begins at approximately 20 months into HIV infection, not 10 years as currently conceived, thereby changing the distribution curve. (Infants born with HIV infection typically survived nine months.) This situation was exemplified by the first two years of the AIDS epidemic in the US. By August 1983, 38% of all known AIDS patients had died. The death rate was 71% for any patients diagnosed more than a year previously. Only 2% – 5% of patients survived five years after developing opportunistic disease(s).

These mortality rates represent patient outcomes among “untreated” patients. Essentially, prior to 1985, these AIDS patients remained “untreated” because no available medications effectively treated HIV infection and its consequent opportunistic infections. In South Africa, one should expect comparable patient outcomes. The greater majority of the indigent Africans purported to have HIV infection would also remain untreated because of lack of access to adequate medical care. Per UNAIDS estimate, South Africa had 2,900,000 people living with HIV/AIDS in 1998. If this estimate were correct, then at least 1.1 million (38%) should have died by the end of 2002. This four-year time period allows two years for incubation; then, once opportunistic diseases have appeared, approximately 38% of these AIDS patients should have died within the following two-year period, presuming a death rate comparable to that of their American counterparts. Even allowing a mean 11-year survival period, the upper level inducted into the computer models, a substantial portion of these 2.9 million people should have died by 2008. Yet, South Africa tabulated a total of 136,000 HIV/AIDS deaths for 1997 – 2008, inclusive.

The second problem with the computer models is their utilisation of HIV seroprevalence data - surveys conducted with the HIV antibody test. The most widely available epidemiological data on HIV/AIDS in Africa are seroprevalence data, and, simply stated, the HIV assays are invalid among select indigent, tropical populations.

In Africa, the populations purported to be afflicted with HIV/AIDS epidemics also are typically afflicted by tuberculosis, pneumonias, diarrheal illness, and other adverse health conditions secondary to poverty, such as malnutrition and likely exposure to insanitary food and water. Although these medical conditions themselves apparently have no direct statistical or chemical correlation with HIV seropositivity, their presence presumably serves as marker – a “red flag” – for populations whose immune systems are chronically inflamed. Antibodies generated by such inflamed immune systems apparently react with the HIV proteins and/or other chemical components of the HIV assay; yielding inordinately high levels of false-positives. For example, South Africa, the HIV seroprevalence rate of first-time pregnant women averages 25% to 30%. The South African health authorities utilise these data from antenatal clinics in computer models to calculate the national HIV prevalence rate (17%), and the estimated number of PLWH (people living with HIV/AIDS) in South Africa (5.6 million). (Health authorities in South Africa do not believe in the validity of their own empirical findings, i.e. the death counts. Rather, their faith lies in the WHO/UNAIDS computer models.)

Such HIV seroprevalence rates exceed all human plausibility of heterosexual HIV transmission. Theoretically, given the relative per exposure risk of HIV transmission during anal intercourse versus vaginal intercourse, the black African heterosexual men of South Africa would require sexual contact with approximately 100 – 400 different female partners every six months - presumably multiple times with each partner - in order to instigate an HIV/AIDS epidemic comparable to that seen among gay men in New York City at the beginning of the AIDS epidemic. (Prior to AIDS, gay men in NYC averaged 20 different sexual partners every six months; the efficiency of HIV transmission to receptive partner during anal intercourse is approximately five – 20 greater than during vaginal intercourse. Reminder: not all gay men are highly sexually active nor engage in anal intercourse.)

These rudimentary calculations should not be considered quantitatively accurate. Rather, these numbers should be used qualitatively, i.e.‘Given these theoretical transmission rates, and the different social climes of gay men in New York City and the rural villages of South Africa, does the concept of a decimating heterosexual HIV/AIDS epidemic among the rural populations of South Africa seem possible?’ The qualitative question is does this concept ‘pass’ or ‘fail’? Or, rather, do the words of research fellow Dr Stuart Derbyshire seem more appropriate and prophetic? “The danger of the AIDS epidemic is dwarfed by 3.5 million deaths from tuberculosis and 16.8 million deaths from malaria since the beginning of the AIDS epidemic. The frightening scenario looms that widespread, but curable, diseases are wrongly classified as AIDS-related complex, thereby foregoing appropriate treatment.”

This article was edited on 5/1/2012 to correct an error in the first paragraph. It had previously stated that UNAIDS had estimated 360,000 HIV/AIDS deaths in South Africa in 1997. This is incorrect. 360,000 is a cumulative figure up to and including 1997, not 1997 alone. The correct figure, now amended in the article is 140,000.

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"However, after tabulating all death certificates for 1997, South Africa attributed only 6,635 deaths to HIV/AIDS"But this figure has been heavily criticised:http://www.ncbi.nlm.nih.gov/pubmed/15668545http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2805%2917918-5/fulltext?_eventId=login In short, South African Government figures from death certificates massively under-reported HIV/ AIDS as a cause. Underlying causes may have been political (Mbeki-regime down-playing of AIDS), social (due to stigma, families do not want their deceased relatives to be labelled as AIDS victims), or simply medical misclassification (doctors may not have known the patient was HIV positive, but symptoms of other disease were obvious). Early statistics on HIV prevalence that extrapolated population prevalence from studies on pregnant women (necessarily participating in unprotected sex) probably did overstate national prevalence. But now models have corrected for this, I am yet to see any studies that provide a serious counter-argument to the UNAIDS/ WHO figures. 

EdwardJoy, you might be interested in a more recent analysis of the under reporting of HIV/AIDS deaths in South African death notifications, published earlier this year.. http://www.who.int/bulletin/volumes/89/4/11-086280.pdf Chris Jennings cites Statistics South Africa to support his claims, assuming that stated cause of death on death notifications is a reliable count of actual HIV/AIDS deaths, when SSA have themselves explicitly refuted this assumption: "Many HIV deaths are registered as being due to some other cause of death. This problem is aggravated by the fact that HIV is not a reportable disease in South Africa, unlike some other communicable diseases. Based on the age pattern of death rates by sex, it is likely that a high proportion of deaths registered as due to parasitic diseases, parasitic opportunistic infections, certain disorders of the immune mechanism and maternal conditions (females only) are actually caused by HIV. Some registered causes of death rise to a peak with age but then decline at older ages more slowly than HIV, especially for males. For these registered causes of death, some of the deaths are likely actually due to HIV, but some of the deaths are likely due to something other than HIV. These causes of death include all infectious diseases, tuberculosis, malaria and nutritional deficiencies."http://www.statssa.gov.za/PublicationsHTML/Report-03-09-052004/html/Report-03-09-052004.html

Again, Snout – your knowledge it topical and you cherry pick the typical articles that receive wide distribution without much critical analysis. Yes, HIV/AIDS is not a notifiable disease in South Africa, which is why the only people reported by SSA are African Blacks.  There are no AIDS cases reported for Whites, Asians, or Coloured.  The conversation I had with SSA is reported in my book and to paraphrase them:  “People don’t undergo the HIV antibody test report because they could lose their life insurance, so cooperative doctors write down the cause of death as ‘pneumonia’ (for example), not HIV/AIDS.  But for the people who have nothing to lose, they willing the blood test because people with communicable diseases in South Africa receive free health care.  So, the only reported deaths occur among indigent Black Africans in South Africa.   The legitimate cases of AIDS, among white gay men, for example, go unreported.  World wide, HIV/AID is an urban disease of the middle and upper classes.  The freedom for widespread anonymous sex required for widespread HIV transmission can not occur in the small, conservative village settings.

Chris, the fact that neither HIV infection or AIDS are notifiable diseases in South Africa means that no cases are officially reported in anyone - black, white, or coloured. You are confusing the notification of cases of a disease with the reporting of deaths. They are completely different reporting systems.

Oh - and of course I have the article at the end of this link ( http://www.who.int/bulletin/volumes/89/4/11-086280.pdf) in my library.  ("Exposing misclassified HIV/AIDS deaths in South Africa").I don't have time now, but when I have time and access to a medical library.  I'll tear it apart.Again -- South Africa has 17% HIV seropositivity equally distributed among males and females among heterosexuals in absence of any large populations of urban gay men and/or IV drug users?   While the use has a prevalence of approximately 0.6% while having large populations of the two high-risk groups for blood-borne diseases?  Statistically male-to-female HIV transmission occurs 1 per 500 episodes of unprotected vaginal sex?   And HIV/AIDS deaths are supposed to surpass TB deaths, wherein a person with TB could theoretically infect several people in the same room with one cough?The who conceptual paradigm of the overwhelming, decimating, wipe-out-the-populations-of-entire-countries HIV/AIDS epidemic is absurd to the extreme.  

Hello Edward Joy and Snout –Good to see you here Snout.  I see you are poking around.  Question 1:  Are you able to admit you’ve learned something from our conversations?  Or are you only able to criticize?Question 2:  Do you still believe that HIV came from African primates?  Or have you discovered and learned from my other internet article posted on this issue?

Sorry, Chris, but your article attempting to refute the African origin of HIV is a nonsensical strawman.It is true that the similarity between SIVagm (which occurs naturally in African green monkeys) and HIV-1 initially led to its misidentification as HIV-1's likely progenitor. However, this misidentification was quickly corrected, and hasn't been current for a quarter of a century.The molecular phylogeny of both HIV-1 and HIV-2 place both viruses firmly within the SIV clade: HIV-1 is almost identical to one particular lineage of SIVcpz endemic to chimpanzees in Southern Cameroon, and HIV-2 is similarly related to SIVsmm, endemic to sooty magabees. I think you need to read up on the molecular phylogeny of lentiviruses. Start here:http://www.hiv.lanl.gov/content/sequence/HIV/COMPENDIUM/2000/partI/Foley...  

Snout, again, you cite an article that I already have in my libary.More computer analysis with the same set of assumptions and connections that limits the searchers to the primate viruses.  In summary, like many computer analysese -- "Garbage In, Garbage Out."I can not study and countermand all innumrable studies and analysis of this sort.  Rather, in my book, I focus on and discredit the two key studies on which all this nonsense is based.First -- the theory that HIV originated in African primates was spawned by an incident of laboratory contamination.  This spawned the theory and was disproven 3 years later, as succintly described in my article on New Africa Analysis:  http://newafricaanalysis.co.uk/index.php/2011/11/the-fallacy-of-hiv-afri...As stated in this article, overall, all the African primate viruses share approximately 75% homology with each other but only 50% homology with HIV.  Again, all these studies collectively examine a few genes that are the mostly highly conserved among retroviruses.  HIV also shares approximately 40-50% homology among these conserved genes with the pathogenic visuses found among ungulates (hooved animals) -- not that anybody is looking.Second, the other key study is Gao et al about the origin of HIV among chimpanzees (Pan troglydytes troglydytes).  What's funny, is I'm sure the authors performed this study as a laboratory and intellectual exercise and didn't expect their findings to be taken so seriously.  They list 5 reasons themselves why their findings might not be valid.  I address this in my book in detail -- drawing from their study.  All these computer-generated analysis rely heavily on various assumptions, and their basic assumption (hypotheses) is that these links are valid.  We need some scientists to exercise the alternative hypotheses.You knowledge is limited and your reading is cursory.   And, sadly, believe virologists is a bad habit.  The only two primate viruses that legitimately induce a cell-mediate immune defect are HIV and SIVagm -- both of which were isolated from primates (humans and Rhesus macaques) living in the United States.   None of the African primate viruses induce a T-cell defect analogous to HIV, none have any particular affinity for the CD4 recepter, and all are misnomers -- they don't induce immunodeficiency.  So the virologists sadly are the last ones to trust -- they are forced by realistics circumstances to use inaccurate semantics to obtain funding for this decade's hot research items. 

And the fallacy that HIV-1 is closely related to HIV-2 is another fallacy I'll eventually dismantle.It is much more possible that HIV-2 emanated from sooty mangabey monkeys.  Why is this possible, because the prevalence of HIV-2 among human populations is in the same geographic location of sooty mangabey monkeys, i.e., West Africa.Oh, but one problem.  The prevelance of HIV-2 among human is highest in urban areas, NOT in rural areas where sooty mangabeys are found both wild and as household pets.AND, of you read the very first reports of HIV-2 (not the reports of the illegitimate HTLV-IV/HIV-2 "discovered by Max Essex in Sengalese prostitutes), then you know that 7 of the 8 cases -- the very first cases -- where among humans who had at one point resided in Europe.  (I may by off on the numbers a bit here,this is all from memory).  The one exception, I think she was a member fo the first reported by Clavell, was it?   She was a grandmother from the Azores?  or was it the Canaries?   She had never been to Europe.Again, HIV-2 and the other primate viruses share about 75% homology among convervsed genes, but only HIV-2 and HIV-1 share only 50% homology.And the clades are defined by humans.  Virologists   The clades and their distinct regimens are not etched in stone nor Nature.  Such definitions are made by virologists, i.e., people with vested interests. 

I wanted to make sure that other readers are able to read my excellent, concise, and revealing article entitled:  The Fallacy of HIV's African Origin at:  http://newafricaanalysis.co.uk/index.php/2011/11/the-fallacy-of-hiv-afri....You, of course, refer to it as a nonsensical strawman.This article reveals how the fallacy of HIV's African origin was instigated by an incident of laboratory contamination.  And, yes, officially, this contamination and related fallacy were revealed 3 years later, in 1988.  However, this knowledge has yet to reach the general population at large was well as the medical and scientific community at large.  Even many virologists -- specialists -- are unlikely to be cognizant of this fact.And as for correction, the fallacy that HIV came from Africa persists, so this fallacy was not corrected.Now don't tell me again that I have to read something that I already have in my library, such as  "An overview of the molecular phylogeny of lentiviruses," (http://www.hiv.lanl.gov/content/sequence/HIV/COMPENDIUM/2000/partI/Foley...) aprticuarly since you have failed to read and criticize these reports in the same vein that you criticize my writing (another thing - you never admit when you are wrong and you never admit to learning anything, so my patience with you is about over). I have collected and reviewed a large segment of the HIV publications generated by the Los Alamos Laboratory.   My books are essentially history of science works, and I detail in history where science diverged onto invalid tangential themes, so I am not required (nor is it possible) for my to follow each of this non-valid pathways of inquiry to discredit the innumerable computerized pertubations of assumptions and analyses designed to prove established and inaccurate preconceptions.  I forget my mathematical terminology, but this report and innumerable others are essentially proofs based on invalid theorems.You are sadly typical in that you seem to believe anything you read in the medical and scientific liteature without due consideration of evaluation by in-depth evaluation within the same universe literature and the agendas of the authors of the aritcle.  Sadly, have read now approximately 3500-4000 articles within the HIV/AIDS domain, it is obvious that many authors of the literature, themselves, never read beyond the abstract or the articles the cite.But that is the nature of the beast, these days. It is virtually impossible for a working scientist to devote the time to literature review that should be appropriate.  And this is not news to anyone familar with working scientists.Start criticizing the literature in the manner you criticize my work, and you'll come to a new understanding.  But it takes lots of time.  Don't think you add anything to the discussion by these surfing exercises and cherry-picking of reports that appear to support your preconceived viewpoint. And don't necessaily assume that all working scientist and researchers don't know the facts I present either.  Undoubtedly, some do but simply keep their mouths shut and their head down.  Particuarly among African professionals, I am learning more and more that people are silent but not unaware. 

Snout, I sometimes I miss the entire point and inaccuracy of your statements.You state the following:  "...similarity between SIVagm (which occurs naturally in African green monkeys) and HIV-1 initially led to its misidentification as HIV-1's likely progenitor..."This is an entirely inaccurate statement. There was no confusion about simularity.  The theory that HIV arose from African primates was due to an incident of laboratory contamination.  When this contaminate was discovered, it was revealed in Nature.  But the story doesn't stop there.  The scientists involved in this contamination incident perpetuated the fallacy with a subsequent publication in Scientific American.There are now many SIVagms.  But my article is about the FIRST one, which was desginated STLV-IIIagm when first discovered (and later renamed to SIVagm).SIVagm was first "discovered" in the blood samples of wild caught African Green Monkeys.  Thus, after the "discovery" of an "AIDS-like" virus in AGMs, the theory that HIV originated in Africa was spawned.When the truth came out, what was thought to be SIVagm from Africa was actually SIVmac (STLV-IIImac).   SIVmac had been originally isolated from 4 sick Rhesus macaque monkeys who resided in Southborough, Massachusetts.  Phyllis Kanki, who had discovered SIVmac (more precisely identified as SIVmac-251), had given samples to Max Essex at the Harvard School of Public Health, and these gift samples contamined the blood samples of the African Green Monkeys brought over from Africa.   This contamination occurred in the laboratory of the Harvard School of Public Health.  When SIVmac-251 was "discovered" in the blood of the AGMs, it was incorrectly thought to be a new virus from Africa and was named SIVagm (STLV-IIIagm) >>> thereby spawing the African origin theory.I do not think you are so dishonest as to have distorted this story intentionally, but it is obvious from several of your postings here and otherwise that you are reading with such strong preconceptions that you not absorbing that data made available to you.Again, this is all explained in detail and in better prose at:  http://newafricaanalysis.co.uk/index.php/2011/11/the-fallacy-of-hiv-afri... 

Now, to address your comments as a duo.   I fear I must address the reality of the situation from several perspectives.Sadly, the health and statistical authorities of the Republic of South Africa do not grant validity to their own empirical findings, that is, the tabulations of their death notification.  Rather, they grant validity to the mathematical models generated by WHO/UNAIDS, and the similar models used internally (utilizing the same false assumptions; specifically, granting validity to HIV sero-surveillance outcomes and the 8-11 year incubation periods).Let’s look that this issue from several perspectives of reality on the ground. 

The first reality on the ground -- anyone who works in the SA Department of Health and/or Statistics South Africa who knows or suspects that the UNAIDS/WHO epidemiological models are hyperbolic will not speak out for fear of losing their job.  Case in point – Mbeki was ostracized for speaking the truth.  It’s hard to determine what Mbeki actually believed or said – give the obvious distortions and denigrations of the international media – but contrary to popular belief (imposed by these denigrations), Mbeki is not some ignorant black savage.  Mbeki has a degree in Economics from the University of London, i.e., he is a numbers man.  When the “AIDS cowboys” or “AIDS bwanas” from UNAIDS/WHO (as they are referred to derisively by some locals) came to South Africa, Mbeki was too astute to accept their absurd statistical projections.  He understands statistics.  So, as far as I can tell from this remote perspective, Mbeki spoke the truth as he saw it.  He stated something to the effect “Nonsense, this is not AIDS, my people are dying from the same old diseases that we have always had, and since they can’t afford antibiotics and medical care, they will continue to treat them in the traditional way.”Consequently the AIDS cowboys rounded up the international media and Mbeki was roasted in the press.  A highly visible example was made of anyone who dared opposed UNAIDS/WHO (there is simply too much money involved).  The mainstream media – as we all know too well – echo the halls of power; thereby echoing the voices of corruption in doing so.  (I will not address overt corruption here; I’ll leave that for another soon forthcoming author). Therefore, anyone else in South Africa who knows or suspects the truth will be afraid to speak openly; otherwise, they will lose their job, just as the President Mbeki did.

The second reality on the ground -- they sources you cite suggest that many other diseases are being misclassified as HIV/AIDS.  However, if you read the SA’s own documents fully, they proffer both theories (1) other diseases may be misclassified as HIV/AIDS, and (2) HIV/AIDS may be misclassified as other diseases.  The question is which way lies the equilibrium?  Not that it matters, since HIV/AIDS is not epidemic there.The third reality on the ground – Edward, you repeat the same old rant: “due to stigma, families do not want their deceased relatives to be labeled as AIDS victims.”This and your other speculations; namely:  “Underlying causes may have been:  (1)    political (Mbeki-regime down-playing of AIDS),  (2)    social (due to stigma, families do not want their deceased relatives to be labeled as AIDS victims),  (3)    or simply medical misclassification (doctors may not have known the patient was HIV positive, but symptoms of other disease were obvious) ] – are exactly that:  THEY ARE SPECULATIONS.  This nonsense has been ongoing consistently throughout the history of the African AIDS “epidemic.”

For the fun of it, let us review some of these speculations as to why HIV/AIDS is [purpotedly] epidemic in Africa . . .But wait !!!  First let’s talk about Haiti.  After all, AIDS was suspected to have originated in Haiti about a year or two before the African theory came into play.In Haiti, the SPECULATION was that Voodoo practices (the drinking of blood) were responsible for the spread of AIDS in Haiti (along with all that black savage sex).  The reality of the ground?   Eventually it was revealed that heterosexual Haiti men were prostituting themselves to North American and European gay tourist for approximately $10 a night – or a third of the annual income for the indigent of Haiti.  (The figure of $10 was given to me by a gay man who told me of his sexual adventures in Haiti.  This gay man hired a young Haitian man for $10 for the night, and the next day the man, his wife, and his children all returned to the gay man the next day -- all dressed in their "Sunday best," and the wife kissed the hand of the American gay man and said over and over:  "Thank you for hiring my husband.  Thank you.  Thank you.) These heterosexual Haiti men than transmitted HIV to their wives and/or girlfriends.  Port-au-Prince was the epicenter of AIDS in Haiti, and also the center of gay tourism.   Gay sex magazines in the United States used to advertise gay sex clubs in Haiti.   

Two years later, after the first Africans were diagnosed with AIDS (all residents of Belgium – they all denied homosexuality), the theory for the origin of AIDS was switched to Africa, with the SPECULATION of (1) polygamy, (2) scarification rituals, (3) re-used syringes, (4) blood transfusions, (5) truckers as being responsible for the purported epidemic.  (Actually, due to the presence of anti-human antibodies in blood transfusion recipients, blood transfusion recipients were likely to generate false-positives due to their anti-human antibodies cross-reacting with the human antigens in the HIV assays, these human antigens stemming from the lymphocyte cultures in which HIV were cultured).And OH – I almost forgot – the lack of circumcision.All remain speculative – nothing particularly substantial or reproducible as far as any survey outcomes supporting this speculations.  And Snout, as I suggested previously, if you really want to apply your obvious intelligence in a useful manner, you could gather up 200 or 300 journal articles about circumcision and apply your astute critical capability to unraveling all the undue and nonsensical justification for this horror of an intervention.  I simply don’t have time to do so at this point in time.  Pay particular attention to the statistical studies.  If you performed such an endeavor, instead of surfing PubMed and throwing abstracts at me, you would come to a new understand of what you think you know. 

And Snout – you absolutely state:  “Based it is likely that a high proportion of deaths registered as due to parasitic diseases, parasitic opportunistic infections, certain disorders of the on the age pattern of death rates by sex, immune mechanism and maternal conditions (females only) are actually caused by HIV.”If you had read more carefully, you would have noted that 84% (? from memory, perhaps it was 86%) of these parasitic infections were attributed to malaria.  Only 16% were attributed to the other four diseases which can occur in the presence of absence of HIV infection, but are also reliably considered as AIDS-defining disease  Also, the age pattern of purported HIV infection is the same as the age pattern of a number of other communicable diseases, I forget which specifically, but since I already stated them specifically on the pharmaphorum site, and I’m not going to repeat myself here.But:  shame on you !  I already addressed this issue previously on pharmaphorum and you try to slip it by here as valid. 

No, Chris, it was not me who said this. I was quoting from a mortality report from Statistics South Africa. It is misleading of you to cite SSA when you say, "South Africa tabulated a total of 136,000 HIV/AIDS deaths for 1997 – 2008, inclusive" as if it were SSA were claiming that this represents anything like the total number of deaths due to HIV/AIDS. Nor are malaria deaths counted among the parasitic opportunistic diseases category. If you read the quote carefully you will note they are kept separate.

Duh ... no kidding.Sadly, SSA and the health authorities of South Africa grant more validity to the implausible computer-generated estimates than to their own empirical death counts.  This is obvious to anyone familiar with the situation. However, not all members of the health and statistical established are true believers.  I am now hearing anecdotal accounts of knowledgable who don't believe in the UNAIDS/WHO stats, but they are afraid to come forth because they fear for their jobs. As I said, if the President can be castigated in the international press at the behest of the AIDS bwanas, that what chance does a working person have?  There are people who know better, but they are afriad to speak out.  

Read again Snout.  I was correct in memory, in increase of death in the 4 "AIDS-defining" diseaes were only 14% of parasitic diseases.  As I stated, 86% of parasitic diseaes (talking deaths here) were due to malaria (in 2004).  Excerpts and citation below.Not a bad memory, huh?Anderson B, Phillips H. Adult mortality (age 15-64) based on death notification data in South Africa: 1997-2004. In: Africa SS, ed. Pretoria, South Africa: Statistics South Africa; 2006.Page 112:The increase in the number of deaths from parasitic diseases between 1997 and 2004 was mainly due to the increase in 4 parasitic opportunistic infections (candidiasis, cryptococcosis, toxoplasmosis and pneumocytosis) that are especially common and likely to be fatal in persons with compromised immune systems, such as those who are HIV-positive.Once the four parasitic opportunistic infections are removed, malaria accounted for 86% of the remaining deaths from parasitic diseases in 2004. Overall mortality for both sexes from malaria increased from 1997 to 1999 and decreased in every year after 1999. The male age-standardised death rate malaria for age 15-64 was higher than the female rate, although the gap between the rates for the two sexes narrowed after 2000. Also, I have come to a new understanding that malnutrition in itself also induces a defect in cell-mediated immunity, thus some of these increases might also be due to increase rates of malnutrition -- which fits the profile of HIV/AIDS cases in Africa overall.  The two most common presenting symptoms as well as the two common symptoms of "HIV infection" in Africa are weight loss and diarrhea.   Weight loss is associated with TB too.  And diarrhea is associated with malnutrition as well as intestinal infection.  In fact, mortality rates are greatly increased with amoebiasis (amoeba infection) is combined with malnutrition.  In my brief "snout-like" surfing of PubMed, the prevalene rates of amoebisis in African populations various from up to 20% to up to 50%.  (But my an appropriate literature research, reading session, and collation of data on this issue has not been performed to my own standards yet) 

And Edward Joy, you state:  “But now models have corrected for this, I am yet to see any studies that provide a serious counter-argument to the UNAIDS/ WHO figures.”Gather this 6, 7, or 8 of the SA reports on causes of death from 1997-2008 and read them, and then add up the numbers.   UNAIDS/WHO stated 2.9 people living with AIDS in 1997.  Try to compile 2.9 million deaths by 2008, even allowing for the UNAIDS/WHO’s absurd HIV/AIDS death estimates, in which half of South Africa’s annual deaths are purportedly attributed to HIV/AIDS.Think about that a minute.  HALF of a country’s deaths due to HIV/AIDS alone.  Think about it. 

DJL, my views are quite simple about this mttaer (call them pedestrian if you like):1. Read ALL of Mbeki’s comments at the time (1999 – 2000) and subsequently, and you will find that at no point doe he say HIV does not cause AIDS.2. Read Mbeki’s comments and approach to policy formulation and you will see that he did not approach HIV/AIDS any differently from his consideration of other policy issues (i.e. (1) Identification of the issue/problem/mischief, (2) assess the need for a new policy, (3)Consult with stakeholders, (4) determine requirements to address mischief (5) gather information about existing and/or similar (6) develop guiding principles (7) prepare “draft” policy for stakeholder engagement (8) revise draft policy after stakeholder feedback (9) adopt policy). All this without preconceptions.3. Consistent with this approach stakeholders were engaged, regardless of the merits or demerits of their views, consistent with an open discourse of a serious national crisis requiring inclusiveness. Note that he did not make his own views known as this would invariably align the policy formulation outcome to his own views. The breadth of stakeholders and the inclusion of “denialists” and “dissidents” was interpreted by some as evidence of support for their views. Curiously, the inclusion of “orthodox” scientists was never interpreted as evidence of his support for them. When pressed on this issue, he refused to make his views know as, to paraphrase him, because the very act of making his views known would be acceptance or rejection of a set paradigm (i.e. why consult widely if you have already accepted a paradigm). [“That's one of the issues that the scientists are discussing. I've never made any judgement on that. It is an issue they are debating, Mbeki] 4. With the above in mind read material on the disagreements and debates amongst those who support the HIV/AIDS paradigm about how to address. Some believe ARVs are the solution and disagree amongst themselves on how they must be administered. Some reject ARVs and believe in using all resources on prevention (such as a vaccine) or in finding a cure. Expand the mttaer to those who believe HIV does not cause AIDS and their own internal disagreements and you start finding that the consensus that is so often trumpeted does not exist in reality. What to do as a policy make?:you consider the approach that optimizes the resources of your country by doing a total socio-economic need analysis and integrating the HIV/Aids strategy to these other needs. Therefore HIV stops being merely a medical issue but is addressed in conjunction with other things (i.e. you must necessarily educate, therefore incorporate prevention to the curriculum, you must establish sustainable human settlements and shelter, therefore design them in a manner that does not lead to slums and related social ills and eradicate human settlements that tend to facilitate social ills such as promiscuity, etc, you must provide primary health care that eradicates the opportunistic diseases of poverty therefore reducing the likelihood of the degradation of the immune systems of those who are infected, you must foster gender equality and empower women, therefore eradicating the social imbalances that devalue the ability of women to decide on their sexuality, you must strengthen research institutions to facilitate the finding of a cure, you must engage drug companies in international trade organs, the courts, etc, to force them to reduce the price of drugs, which was achieved, etc, etc, etc). All this is more comprehensive than popping a miracle pill, and all this requires more consented effort, and a vision that most journalists do not have. Hence none of this was communicated to our people, hence the summation by many that Mbeki’s acts in combination meant he did not believe HIV cases AIDS. 5. To state that “Lets at least admit that by his “questioning of the link” and influence he had on his ministers it resulted in at least a portion of the AIDS sufferers in this country to die an early death’ is patently absurd and is based on a supposition that ARVs work. Yes I support people being given the choice to pop the pill but I reject the efficacy of ARVs. Frankly, I believe they are a poison and suggest that you read of them in detail (read particularly the recent findings of the “antiretroviral therapy Cohort Collaborative, read also about the FDA approval of AZT and the dodgy process that was followed, read also of the so-called concorde study). Any “treatment” that has a 50/50 chance of treating you and also has a 50/50 chance of actually killing you IS A POISON. To use the analogy of chemotherapy (as I know some will do) is simply disingenuous, after all you do not have chemotherapy everyday until the day you die (but you must take a drug everyday until you die, a drug which was created precisely to kill cancer cells and was found to kill them AND the healthy cells! For your information, and I know this for a fact and not from hearsay, Mbeki does believe HIV causes AIDS but he rejects ARVs as the biggest con in history and his biggest regret in his professional life is not to having spoken out more against them. He believes that the focus should be on prevention (including the search for a vaccine), treatment of the opportunistic diseases, and the search for a cure. He believes firmly that the disengagement between the orthodox and dissident scientists is self defeating as they respectively run the risk of not being able to consider relevant factors and/or considering irrelevant factors. As stated in one of my other postings, speak to any individual in townships where ARVs have been rolled out and ask them how many young people are dying from anemia and other side effects of ARVs (what killed them, AIDS or the ARVs, or is this irrelevant because, argh, they were in any event going to die anyway?). Lastly, (and mark my words) South Africa and India are going to become the most important revenue base for the big pharma peddlers of ARVs. We are going to have problems with increased resistance and therefore the need for stronger ARV combinations, we are going to see ordinary diseases becoming drug resistant (like the recent TB cases, only worse) as more and more people with HIV and on ARVs inadvertently spreading the more resistant strains to non-HIV individuls, we are going to see higher levels of HIV infection as more and more people accepting HIV as an ordinary disease “curable” with ARVs. As all this happens, with PdV being the chief praise singer, Big Pharma will be reaping handsome rewards from this travesty, spending R&D on more sophisticated ARVs and not cures or vaccines (because of the higher returns). The scandal is bigger than the arms deal!!!! Mark my words.

Hi Marta -  Thanks for your long discourse.  Too much to go into and much beyond my realm(s) of research.  My works are essentially history-of-science pieces and my goal is to expose all the non-sequitors and fallacies that have created a conceptual house-of-cards relative to the size, scale, and scope of the HIV/AIDS epidemic, particularly in Africa. I have not focuses on the treatment aspect because it is much too large and endeavor and I believe it is one of the areas of HIV/AIDS research that is appropriately being pursued by some excellent doctors and scientists.  The actual role and actions of the pharmas at one point or another can always be called into question.  However, in my opinion, the pharmaceuticals and the diagnostic companie did not create these fallacies and misconceptions.  Rather, UNAIDS and  WHO were the principal drivers, and if any specific group of scientists is at fault for perpetuate and adding to the misconceptions and fallacies, it is the virologists.However, I work for the pharmas and the diaganostics, so I am somewhat biased.  Only once in my experience have I come across unethical behavior on the part of the company, and every body on contract team refused to go along with the unethical behavior.  Of course, the research level and the C-level (CEO, CFO) are entirely different entitites and driven by different agendas.In my experience, writing clinical study reports on ARVs for the drug approval process in the Unites States, the ARVs have demonstrated clinical (health) benefits.  Also, from anecdotal reports of people infected with HIV, the ARVs have been life-savers -- recovering them from life-threatening illness and in some cases making their viral load undectecable.For me, the problem in Africa is that among indigent populations, people are being treated with ARVs in absence of HIV infection.  So unless there are other unrecognized retroviruses present, the medicines induce toxic effects in absence of benefits.  Most medicines ARE poisons, but hopefully they kill the agents of disease faster than the kill the patient.  So the whole formula always discussed in the pharmaceutical arena is the benefit-risk analysis.Among people legitimately infected with HIV (and there are undoubtedly plenty of people in Africa infected with HIV, mostly like urban gay males -- and in African, as viewed from afar, being openly gay is not allowed among the black populations, so these closeted gay men contract HIV/AIDS from other gay men and then infect their wives and girlfriends -- in the Western world, heterosexual transmission is most frequent in the settings of among long-term relationships (but this is from memory, I couldn't cite the studies to prove this right now). But among the uninfected, and undoubtedly, (or in my opinion). it is not possible that the 6.6 million Africans who received ARVs as of 2008 are all infected with HIV.  Rather, IMO, the majority are not.IMO, the HIV antibody tests are highly inaccurate among tropical indigent populations. Why?  At this point can only speculate and I'm not going to do so here.  I have long descriptions of the pitfalls of testing in my book but none of them are definitive. Ultimately, give the rates of heterosexual HIV transmission, the only reasonable conclusion is that the HIV antibody assays are inaccurate in these settings.  (and genital warts and concurrent STDs can not explain away the orders of magnitude between sero-survey outcomes and plausible heteroseuxa transmission rates.

"It comes with a cop car attached." I don't rmmeeber exactly when he died, but it was before Bryce.When I got sober in 1987, I met a bunch of folks with AIDS in the rooms. My friend Jeff will never be included in the statistics of AIDS deaths. But I know the reason he hanged himself had to do with the terrible physical discomfort that the conditions his AIDs caused him. My friend Stewart was one of the founders of the gay AA clubhouse here in Philadelphia. He has been gone a long time, but his legacy lives on. One guy I work with goes to a meeting he started that happens at 11:30 every night. Stewart was a waiter, and wanted to be sure that there was a meeting available for folks getting off work late at night. The meeting still meets that need, and has thrived since he started it.Having been raised in the SF Bay Area, and lived in Philadelphia, with a large gay population, and my sister in the artistic community in NYC, I have met countless people with AIDs or HIV, and have known a great many well. And I am convinced that, so long as we allow those at most risk to be marginalized, there will never be a cure. That is where the battle lies.

German - thanks for your message.I have not done much research relative to HIV/AIDS in the States.  I've focused on my two recent books (and two analytical reports prior to that), so i have not followed the US situation.But in terms of treatment, major advances have been made but at great cost to the patient.  the ARVs are a difficult regimen, but I personally know 2 people who recently related to me how effective they've been.  One says his viral load is now undetectable (and his friends all wrote him off years ago).Personally, I am a supported of gay rights and the end of all forms of oppression.   From a medical standpoint, oppressed people engage in "adverse health behaviors."  And now we are seeing a rise of HIV infection among some Western populations of gay men. I did not record the site, but it was an online publication that I read of late from Canada.  Ottawa, I think, that had a graph showing the rate of HIV infection.  The rates peaked in the late 1980s, and then dropped, but in the last decade they've almost increased again to the peak that occurred in the 1980s.I had a discussion with a gay friend about this, and there is some dynamic -- strongly related to age, meaning the different generations of gay men, wherein in age-bracket seems to be almost embracing high-risk behavior and the contraction of HIV infection.  I wasn't quite clear on the psychology of all this. As for a cure, HIV is a retrovirus and retroviruses are on the edge of scientific and medical understanding.  HIV was only the third known human retrovirus.  Pathogenic retroviruses were known among farm animals, but no cures were ever developed.  Rather, herd destruction was the answer.  Lots of money has been devoted, and major brass ring would be awarded to the scientist that developed a cure. Again, I work as a writer for the pharma industry. At my level, I don't see the corruption and conspiracies that are sometimes evident on the corprate or societal level. (Although different corporations have different personalities.  Even in the industry, one corporation we all know of is viewed as a evil corporation).  On the research level, it's obvious that with the new growing range of drug-resistant infectious oragnisms and diseases like cancer (which is not a single disease, but actually hundreds of individual diseases), we need to develop some new conceptual paradigms in order to change our capacity to deal with these problems.  But paradigm changes happen in their own time frame.  At this time, for the afflicted in the Western world, HIV infection is difficult but not hopeless.  All perhaps youd do is to offer your friends and acquaintances support and direct them to the best specialists.  Not all doctors are equal in their professional abilities and/or support of gay people. 

And where are the Hepatitis B deaths?  Long before the advent of HIV/AIDS, Hepatitis B infection was reportedly endemic in Africa and Asia.  And Hepatitis B is a much hardier virus that is 6 to 30 times more transmissible than HIV.  Where are the Hepatitis B deaths with the yellow eyes and jaundiced skin -- obvious even with black people – that should outnumber the HIV / AIDS deaths?Finally, given the rates of HIV transmission via heterosexual sex, it’s entirely implausible that equal numbers of males and females would have HIV infection.  Also, higher death rates from tuberculosis than from HIV infection make absolute sense.  One person can easily transmit TB to several people simultaneously by coughing in a crowded room; whereas, one man must (statistically) have unprotected vaginal intercourse with a woman 500 times in order to transmit HIV once.So all this nonsense that all TB deaths are being misclassified as HIV/AIDS deaths is just that – nonsense.  The inverse is far more likely to be true.  And tell me, if half of the deaths in SA are due to AIDS – how much of a stigma can HIV infection be?  Back in 2001, UNAIDS/WHO stated that 1 in 4 South Africans were infected. If true, should almost be no people left in the country.  Yet the population keeps on growing.  Can you explain how that is possible?“Iraq has weapons of mass destruction.”  “AIDS is epidemic in Africa.”  Say them both in the same breath.Money and corruption have distorted the science in both cases.   

Chris asks: "And where are the Hepatitis B deaths?" ... Chris, unlike HIV, hepatitis B usually doesn't result in chronic infection. For example, a 1989 serosurvey in KwaZuluNatal found that over 80% of adults had been infected with HBV, but only 4-7% were chronic carriers. See: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1349678/  And even when HBV does cause chronic infection, it is far less lethal than chronic HIV infection. And even then, if someone dies from end stage liver disease caused by HBV, this is not necessarily going to be recorded as such on the death notification, unless the person has been tested, and the person filling in the notification knows the result and its relationship to the terminal disease. Many HBV deaths are likely to be recorded simply as "jaundice" or "cancer" or "dementia" or something else non-specific. Same as HIV deaths. ... You say: "So all this nonsense that all TB deaths are being misclassified as HIV/AIDS deaths is just that – nonsense." Chris, please read more carefully. No one is saying that ALL TB deaths have HIV as their underlying cause (which is what I think you were trying to say). ACTIVE tuberculosis is an opportunistic disease: Hundreds of millions of people in Sub-Saharan Africa have latent TB, most of whom will never develop active TB. But they are 30 times more likely to go on to develop active disease if they have HIV/AIDS. In communities where HIV prevalence is in double figures, HIV is a major underlying contributer to rising rates of ACTIVE tuberculosis. What this means is that in communities where both HIV and TB have high prevalence, you cannot effectively deal with each disease in isolation. You need to have a co-ordinated approach to both simultaneously.

Duh .. no kidding.HBV infection (and/or exposure to HBV as demonstrated by serological assay) does not always result in fulminant Hepatits B infecton.But let's play with the numbers.  Remember, HBV infection is a blood-borne disease, just like HIV infection.  They both share the same transmission vectors.  PLUS HBV can be transmitted horizontally among children (it was a common problem among institutioanlized children, i.e., mentally handicapped in mental institutions) and can also be spread by contaminated bed linen and clothes.So, are far back as 1985, 5% to 15% of Africa and Asia carried the virus.  As demonstrated by needlestick accidents in hospitals, HBV is 20 to 100 times more transmissible as HIV (in needlesticks, HIV is transmitted 3/1000 sticks versus 6- - 300/1000 sticks with HBV.Sexual transmission is another story and the numbers are not so accessible.But let's examine HBV which was a well recognized and characaterized virus decades before HIV ever appeared on the scene.  HBV was also recognized to endemic in Africa and Asia.  Also, the Western world -- United States and Europe -- experiecned a major HBV epidemica in 1970s.  This HBV epidemic of the 1970s was a model for the HIV epidemic of the 1980s. (So all the hype and hysteria of HIV killing everybody was unnecessary.  Blood-borne diseases are common among well-defined risk groups). So, if South Africa has a 17% HIV infection rate, then the rate of HBV infection should be between 340% 1700%.  In other words, it is implausible that anyone infected with HIV is not also seropositive for HBV.  Look around PubMed and see what you find for concurrent infections rates of HBV and HIV in Africa. And, duh, not all of them will become fulminat infections, but since minimally 340 % of the population is infected, the rate of fulminant infections should approach that of HIV prevlance.  And anyone not dying of HIV should die of hepatocellular carcinoma.Now obviously I'm being a bit facetious here.  And non-scientists should not read these logical and numerical games as true science.  But they just point to the absurdity of the conceptual paradigm in which 17% - 25% of African populatons test positive for HIV.And, given our recognition of the invalidty the HIV assays in tropica indigent settings, shouldn't we also now question the validity of the HBV assays in this setting?  

Snout -- the problem with all your logic about the correlation of HIV and TB in these tropical indigent settings in that the HIV prevalence rates are simply nonsense.In these settings, the entire diagnostic algorithm for HIV infection utilizing the HIV assay needs to be reconfigured.  As criticized by many people, TB is not appropriate to be used as an AIDS-defining condition because one can contract TB in absence of HIV infection.  The significane of letigimate HIV infection concurrent with TB is that the clearance of TB requires a competent cell-mediated immunity; otherwise, it's exceedingly difficult to clear.The overwhelming problem is not the misdiagnosis of other diseaes as HIV.  The overwhelming problem is the assumption that HIV infections are being misclassified under other disease classifications.And, again, a little reminder and tibit -- the median longevity of an infant born with HIV infection (in absence of treatment) is 9 months.  So all these children who are beyond toddler age, supposedly infected with HIV -- unlikely.And how many of these people undergoing treatments are underg HAART?  And how many of them are having their viral load actively monitored, so that new ARVs are switched in and out as drug-induced genetic drift creates drug-resistant mutants?  How many of the rural clinics in Africa have PCRs among their equipment?If the majority of the people purportedly infected with HIV in Africa were actually infected with HIV, then all of Africa would be a breeding ground for drug-resistant strains of HIV. 

Regarding the Iraq and the weapons of mass destruction.   The science was good, but the corrupt leaders ignored the science and followed their own agenda.  Poor Collin Powell must live with it now, alhtough he's publicly apologized for being the misleading front man

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