Tuesday, May 10, 2011

Africans Don't Mistrust Science, Just Bigotry Masquerading As Science

The English Guardian has an article entitled 'Epidemics breed public disorder and the breakdown of trust', indeed, 'violent mistrust' of scientists and politicians. The article mentions both the HIV pandemic and Haiti's current cholera epidemic. Cholera is expected to affect up to 800,000 people in Haiti by the end of the year and to cause 11,000 deaths.

A striking similarity between both cholera and HIV is that they spread in countries which were, and continue to be, especially vulnerable. Haiti was already vulnerable before the recent earthquake and hurricane, but things became far more acute afterwards. And the countries with the worst HIV epidemics were vulnerable when the disease began to spread rapidly, for example, most sub-Saharan African countries, or became vulnerable some time later.

The spread of HIV in Eastern European countries is likely to have been facilitated by the breakdown of healthcare services that were available to all during the Soviet era. And in some African countries, the spread of HIV is thought to have been contained in countries that were at war, but that it spread rapidly once peace returned. This phenomenon has not been researched thoroughly but the fact that most health facilities closed during times of severe unrest may have been a factor.

Whether UN personnel from Nepal introduced cholera to Haiti may still be an open question. But the fact that it has infected, and continues to infect, so many makes it clear that people do not have access to adequate supplies of clean water and to effective sanitation facilities. It's the failure to provide people with these vital services that results in high morbidity and mortality, not the mere presence or absence of some pathogen.

Richard Evans' article is as tame as you would expect an article about public health to be in a newspaper whose development section is funded by the Gates Foundation. The foundation is keen on fighting diseases like cholera (and HIV) with vaccines, rather than on addressing the conditions that allow diseases to reach epidemic levels in the first place.

South Africa's ANC may have been wrong in their belief that HIV does not cause AIDS, but not completely wrong about it being part of a white supremacist plot. The Truth and Reconciliation Committee did reveal that the disease was sometimes spread deliberately by HIV positive people, paid to have unprotected sex with HIV negative people. And the public was right to be suspicious of AZT, considering early attempts at using it to treat AIDS killed most patients because the dose was far too high.

Thabo Mbeki may have been wide of the mark in denying the connection between HIV and AIDS but he was not wrong to object to Western stereotypes about African sexuality. These stereotypes are, in fact, the state of the art when it comes to HIV theory. HIV 'prevention' policy still relies entirely on the 'behavioral paradigm', the view that HIV is almost always transmitted sexually in African countries.

Evans' analysis is superficial: you don't need to be a scientist to spot racism. The behavioral paradigm requires the view that Africans (and not non-Africans) have inordinate amounts of sex, with lots of people, and they care little for their own health and welfare or that of their partners or families. Even this history professor should be able to spot that this is not science, it can not be supported by evidence, and all the existing evidence to the contrary has yet to shift adherence to the paradigm.

Thabo Mbeki was not the leader in other African countries where HIV prevalence was higher than that in South Africa, nor in other countries where millions of people are infected. What Mbeki did was wrong, but that doesn't make it right to base public health policy on a crude prejudice, whether that prejudice is against Africans, women, men who have sex with men, injection drug users or any other group.

Evans may have a point about one thing: "Governments and politicians are frequently driven to choose the science that best serves their interest, or their ideological standpoint". But let's not blame science for the fact that the top people in the HIV industry, fronted by UNAIDS, believe something for which there is no evidence for and a lot of evidence against.

Current levels of HIV transmission are not related to bad science, misuse of science or ignorance about science. They are caused by the use of prejudice in the place of science. And it may be wrong to conclude that this is done so that some very rich pharmaceutical companies will get a lot richer. But they definitely will get a lot richer. The problem is not a little bit of dishonesty here and there getting blown out of proportion. The problem is that science developed purely for use by the rich and powerful will ignore or deny anything that is inimical to the interests of the rich and powerful.


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