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More HIV Nonsense in Africa

It is estimated that 5% of people living in Sub-Saharan Africa are infected with HIV – that’s 22.5 million people. Infection rates vary wildly from country to country, with Swaziland having the highest rate at 25.9%. Gambia is below average, at 2% or 18 thousand people, but still has a serious HIV problem, and now finds themselves at the center of the HIV controversy in Africa.

This epidemic has been magnified by unfortunate realities on the ground. Africa has an insufficient public health and medical infrastructure to deal with the massive challenge such an epidemic presents. This has led the World Health Organization to contemplate partnering with local traditional healers, to make them into an extension of the effort to bring modern medical treatment to the HIV-infected in Africa. This desperate strategy is fraught with problems, not the least of which is that most traditional healers have had no prior contact with science-based medicine.

Former South African president Thabo Mbeki seriously set back his country’s HIV efforts by embracing crank HIV denial. Coupled with his denialism was efforts by Health Minister Manto Tshabalala-Msimang to use traditional medicines to treat HIV/AIDS. This combination resulted in restrictions on the distribution of anti-retoviral drugs in South Africa that is estimated to have cost hundreds of thousands of lives.

Tshabalala appealed to local tradition over science and evidence, and in fact resisted attempts to scientifically study her beet-root and other “natural” remedies. She argued that treatment with traditional methods should not get “bogged down in clinical trials” and criticized attempts to impose “Western science” on African methods.

Joining the ranks of leaders contributing to, rather than ameliorating, the HIV epidemic in Africa is Gambian President Yahya Jammeh. He is promoting the traditional medicine approach, adding his own cult of personality angle. He claims to have invented a secret formula of boiled herbs. In a state television address he said:

“Just as the Prophet Mohammed prevailed and established Islam (…)I also prevailed to cure HIV/AIDS to the point that 68 are being discharged today,”

“Who am I to expect that everybody would praise me.”

His herbal treatment also requires that patient stop their anti-retroviral therapy – which has garnered criticism from the WHO. Jammeh’s treatment is also more than just herbs. It has a healthy dollop of religion as well:

The treatment involves several herbal cream applied and consumed over a number of weeks and prayer from the Qur’an. His patients have to renounce alcohol, tea, coffee, theft and sex for the duration of their treatment.

He is also quoted as saying:

“Those who said that HIV/AIDS is not curable may be right because if you don’t know God and you believe that you descended from frog and you are not created by the Almighty Allah or you came to this world through evolution then you would not know that anything that happens in this world good or bad, Allah knows about it and has solutions about it. There is no disease that the Almighty Allah doesn’t know about and there is no disease without a cure.”

This all may seem strange and even primitive, but it is not fundamentally different from any form of faith healing in the West, or even most forms of co-called alternative medicine. The psychological elements are all the same. Treatments often involve avoiding alleged toxins or unhealthy foods or activities, and require a certain amount of faith – if not overtly religious, then in the human energy field, meridians, or magical homeopathic energies.

We also see the mislabeling of magical faith-based treatments as “traditional” in order to make them more palatable. Finally, despite frequent claims that alternative treatments are “complementary” to science-based medicine rather than a replacement for it, they are frequently a replacement for science-based therapies.

Once you reject rigorous science-based standards as the basis for modern medicine, then there is no practical or philosophical difference between whatever “alternative” treatment you offer in its place and the dangerous herbal witchcraft of Jammeh. The only difference between homeopathy, acupuncture, healing touch and Jammeh’s herbs is subjective and cultural.

Posted in: Herbs & Supplements, Public Health

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34 thoughts on “More HIV Nonsense in Africa

  1. windriven says:

    “Those who said that HIV/AIDS is not curable may be right because if you don’t know God and you believe that you descended from frog and you are not created by the Almighty Allah or you came to this world through evolution then you would not know that anything that happens in this world good or bad, Allah knows about it and has solutions about it. There is no disease that the Almighty Allah doesn’t know about and there is no disease without a cure.”

    Also spracht Darwin.

  2. kathy says:

    There’s no way of disentangling medicine from politics in Africa. Sometimes the excuses are ridiculous, on a “the dog ate my homework” level, like this beaut (square brackets are my inserts):

    “The Minister of Health [of South Africa, Tshabalala-Msimang] also promoted an herbal treatment developed by a Dutch nurse composed of African potato extract, olive green leaf extract, and grapefruit seed extract called ‘Africa’s Solution’. Tshabalala-Msimang invited the remedy’s developer to address provincial health ministers and arranged for the provision of the solution to AIDS patients in government hospitals and clinics. Allegedly, the solution was given to over 40,000 people, but the records were destroyed when a burglar urinated on them.”

    Quote taken from http://www.globalizationandhealth.com/content/4/1/5, written by Joseph J Amon of Human Rights Watch.

    Sadly, although this instance is funny, the interaction of governments with medicine in Africa is often far from amusing, and a lot of people have died or (in the case of newborns) been infected because ARV’s were refused for political/cultural reasons.

    An unnoticed group of sufferers too, is those doctors and medical regulators who either blew whistles or silently refused to co-operate with officialdom. Many lost their jobs or were otherwise dealt with. Another quote from the same article, “However, a major obstacle to the further promotion of the ‘cure’ [Virodene] was the refusal by the government’s independent Medicines Control Council (MCC) to provide permission for the continuation of the clinical trial, due to the known toxicity and lack of effectiveness of dimethylformamide [which is an industrial solvent]. Eventually the Minister of Health was able to replace key MCC members”.

    To the credit of the MCC, they still refused to give the go-ahead to the trials, which … just continued anyway. Without ethical approval, in SA and in Tanzania.

    The article also deals a lot with another form of medical scammery, which is conterfeit or adulterated medicines, and which is a very big problem in Africa (and elsewhere).

  3. cervantes says:

    Let’s not forget that Mbeki was in the thrall of an American virologist, with high powered credentials, named Peter Duesberg. His denialism wasn’t based in African magico-religious systems, it was all dressed up as science. One Orac, who may be related to someone known to people here, is among many who have discussed this really sad case.

  4. Janet says:

    I listen to a podcast of a BBC program called “Health Check” which is usually very informative about topical medical issues. I have never in years of listening to it had reason to question the content until last week.

    The segment was about a clinic in Ecuador that is offering “traditional” treatment (or Integrated Medicine as the title says) “side by side” with “modern” medicine. The MD who has put this into place is–and this pains me as an Anthropology major–an anthropologist. Anthropology has apparently been utterly corrupted the last twenty-some years since I have been out of school. I was never taught that cultural relativity included embracing the culture under study. It’s correct to respect the local customs, and no anthropologist has any respect for the proselytizing of missionaries, but there is nothing I was ever taught that would justify this kind of equating traditional healing methods with real medicine. Anthropology (especially ethnography) is about understanding how and why cultural systems arise, which can help societies better adapt to the inevitable change that happens when cultural isolation ends.

    In the podcast, this goal is completely corrupted by bringing the traditional practice into the clinic and offering it “side-by-side”–not as an accommodation, but as an equal. There is a requirement for only a cursory exam before one is referred for the traditional treatment–which amounts to–ready?–driving out the negative energy. The host offers virtually no comment and while her tone is a bit skeptical she comes down in favor of the patient “feeling better”. The host is a woman who usually is very incisive and asks intelligent, penetrating questions.

    Almost every fallacy associated with CAM is present in this broadcast–all presented with little to no skepticism other than to mention that these treatments are not proven, which is quickly followed with a big dose of the shruggies.

    At least the South Africans involved in the AIDS debacle were not MD’s–or anthropologists.

  5. The Dave says:

    I am dumbfounded. I never knew people could deny the existence of HIV until I started paying more attention to skepicism and science-based medicine. Have they not seen the scanning electron microscopy images of the HIV virus? Utterly astounding.

  6. pharmavixen says:

    You didn’t mention the real motivation behind the nonsense: $. When the populace takes beetroot or herbal concoctions instead of staggeringly expensive antiretrovirals, the economic benefits for the country at large are two-fold: sick people die so they are no longer a burden, and the traditional woo remedies are cheap.

    The nonsensical babblings of Mbeki, Jammeh and Tshabalala may look like the usual pointy-headed advocacy for woo in the name of religion/cultural sensitivity/sticking it to Big Pharma/etc but in fact this is hard-headed policy-making at its most sociopathic.

  7. Mark Crislip says:

    Not just the traditional healers and politicians have been a major impediment to HIV care

    The head of the Catholic Church in Mozambique has told the BBC he believes some European-made condoms are infected with HIV deliberately.
    Maputo Archbishop Francisco Chimoio claimed some anti-retroviral drugs were also infected “in order to finish quickly the African people”.

    As best I can tell, this statement has never been retracted

    http://news.bbc.co.uk/2/hi/africa/7014335.stm

  8. nybgrus says:

    @Janet:

    Indeed it has. I was taught the same mumbo-jumbo in my anthropology degree. Granted, not all of it – I had some very good professors as well. But I focused specifically on medical anthro where that is exactly what was taught – quite vehemently at times. I even had a professor start tearing up whilst angrily recounting the “evil reductionists” and how wrong-headed and ideologically based the denial of TCM/Ayurveda, etc as “equally valid systems of healing” was. And it was driven into us that “healing” was different from “medicine” and that “Western BioMedicine” could only treat, but that “alternative” medicine could truly heal.

  9. windriven says:

    @cervantes

    Thanks for the heads up on Duesberg. It is incomprehensible to me that a researcher of his apparent caliber could stray so far into the weeds. But then remember Linus Pauling …

  10. cervantes says:

    Not just Pauling. It’s called the Nobel disease — quite a few Nobel winners have become total cranks. Gorski has discussed it here. A more complete list is here.

  11. mousethatroared says:

    @pharmavixen – I was going to point out how such “cost saving” policies couldn’t save money in the long run, but that is so obvious that it hardly needs to be said. So I’ll just say how thoughly won over I am with your line “this is hard-headed policy-making at its most sociopathic”

  12. Scott says:

    Have they not seen the scanning electron microscopy images of the HIV virus?

    Depending on which crank you ask:
    – They were created in Photoshop.
    – They are of a random virus with no connection to AIDS.
    – They are of something (probably not even a virus, since viruses don’t exist) whose production is a symptom of AIDS.

    1. Harriet Hall says:

      In a discussion with a fruitarian, she told me the images of smallpox virus were cellular debris from the cells removing toxins. I tried to tell her that we could distinguish smallpox from chickenpox by EM, and that we had even deciphered the genome of the smallpox virus. She had no answer to that, but didn’t change her beliefs. Some people say seeing is believing. In this case, believing meant refusing to see what is before your eyes.

  13. elburto says:

    Mark Crislip – added to the disgusting lies of the Catholic church was the American insistence that the promotion of the successful ABC (Abstinence! Birth control! Condoms!) campaign be stopped.

    In order to receive aid from the US, African governments had to agree to scrap all sexual health education, and only teach abstinence. So a policy that’s been disastrous for poverty-stricken communities in America has been, frankly speaking, f*cking catastrophic in Africa.

    The Dave – HIV/AIDS denialism is beyond unbelievable. Then there are the people who insist they have “HIV negative AIDS”, claim they have transmitted it to !partners and children, and claim that it’s a government conspiracy, with HIV/AIDS designed to target and kill “undesirables” and “HIV negative AIDS” (it hurts to bloody type that) designed to target and incapacitate “high-flyers”, in order to create societies solely full of mindless drones.

    Sadly, some people seem programmed to believe anything.

  14. windriven says:

    @pharmavixen

    Taking nothing away from your notion that money trumps science and good public policy and ceding nothing to idiots such as Mbeke:

    “Between 2003 and 2008 the annual price of first line antiretroviral therapy decreased from $1177 (£733; €844) to $96 and foreign assistance for HIV per capita increased from $0.4 to $13.8.” (1)

    $96 per year doesn’t sound like much for lifesaving drugs until you put that in context. Zimbabwe has an estimated unemployment rate of 95% (!) and per capita GDP of $500. (2)

    (1) BMJ 2010;341:c6218
    (2) CIA World Factbook

  15. cervantes says:

    Zimbabwe is the world’s worst economic basket case — most of Africa isn’t that bad off. But, that said, HIV actually harms African economies. It creates a lot of unproductive sick people and orphans. There’s no hope to solve Africa’s economic problems without improving population health — HIV, malaria, tuberculosis, water borne illnesses, you name it. Treating HIV also reduces transmission so it has a public health impact beyond the immediate benefits to the individual and his/her dependents. It’s a good investment, not that there aren’t others that aren’t being made.

  16. Quill says:

    “This desperate strategy is fraught with problems….” is almost a tragicomic understatement. Desperation and fear are usually not very good places to make decisions from, let alone go against long-held traditions and habits that seem to contradict all the “Western science” stuff.

    But what really angers me is people who know better, or should know better, based on their education and culture, people much like the bishop Dr. Crislip noted. It is one thing to try to change old notions and quite another when those notions are being fed by men (almost always men) who value lies over truth.

    HIV denialism has led to the deaths of so many people it is staggering to contemplate especially as not one person need have died.

  17. Quill says:

    Regarding the fruitless discussion with the fruitarian, I guess if an apple a day keeps the doctor a way then nothing but an entire bushel of fruit a day keeps facts at a fair distance.

  18. windriven says:

    @cervantes

    “Zimbabwe is the world’s worst economic basket case — most of Africa isn’t that bad off.”

    I chose it for that reason. Countries with 5 figure per capita GDPs aren’t as critically affected by $100 annualized cost of antiretrovirals as are the basket cases. Interestingly South Africa, with a per capita GDP 20 times that of Zimbabwe actually has a larger fraction of its population living with AIDS than does Zimbabwe (17.8% v. 14.3% but either number is knee-shaking scary).

  19. mobilis says:

    @pharmavixen

    “When the populace takes beetroot or herbal concoctions instead of staggeringly expensive antiretrovirals, the economic benefits for the country at large are two-fold: sick people die so they are no longer a burden, and the traditional woo remedies are cheap.”

    As a South African I have to take issue with this. Antiretrovirals aren’t “staggeringly” expensive, although they’re certainly more expensive than beetroot, especially if the state isn’t paying for the beetroot. I do not believe that was Mbeki’s motivation though. I think he was genuinely led astray on ideological grounds, in part because “Western medicine” has a bit of a toxic (figuratively speaking) history in Africa – unethical drug trials and so on. It is also not an economic benefit for large segments of the population to die, especially when those deaths occur in the most economically active age groups. There are almost 2 million AIDS orphans in South Africa, who are far more expensive than antiretrovirals, both directly, in that they need to be maintained and cared for and indirectly in that to the extent that many of them are not properly cared for and educated, they are a sociological problem waiting to happen.

  20. mousethatroared says:

    @mobilis – I completely agree. I think it’s a pretty well established economic principle that a quality health infrastructure is an national economic advantage.

    I assumed that pharmavixen was talking about individual economic gain in terms of corruption of government officials or those advising them. But it can be read either way.

    It good to get the perspective of someone from South Africa. I’m never really comfortable with our reporting on many of the issues here in the U.S.

  21. @HH,

    Wait till you have a germ theory denier tell you about the scams of growing bacteria on a “peach tree” dish. (Yes.)

  22. pharmavixen says:

    @ mobilis

    I also appreciate hearing your S. African perspective. Perhaps African governments are able to access low-cost generics from India, but IMV anti-retrovirals are pricey. Here are some prices from my wholesaler’s catalogue. As these are wholesale prices, the dispensed price would be more.

    AZT (Zidovudine) 100 mg capsules = $ 196.61/100 (all prices in Canadian dollars which are about the same as US dollars these days). This is the oldest HIV drug and one of the cheapest, at almost $ 2 per capsules. Most adults would take 3 per day;

    Lamivudine (3TC). Each day you’d usually take two of the 150 mg tablets which are $ 306.11/60 or $ 5 each.

    Stavudine (Zerit) 40 mg = $ 312/60 capsules. Another old drug, and a cheaper one, only $ 5/capsule. You’d take two a day;

    Didanosine (Videx) An adult of > 60 kg would take two a day of the 200 mg. They’re $ 182/30, or $ 6 each. If you would rather take one a day of the 400 mg, they’re $ 365/30, or $ 12 each, kinda pricey for one of the older drugs. I can’t remember when I last dispensed this one.

    Indinavir (Crixivan) 400mg, $ 511/180. Before you go thinking that’s a bargain, the usual adult dose is 800 mg every 8 hours, which works out to $ 17 per day.

    Ritonavir (Norvir) 100 mg, $ 185.74/120 or only $ 1.50 per capsule. These days it’s used to boost the effectiveness of other HIV drugs by inhibiting their metabolism.

    Those are a few of the older cheaper drugs. Here’s some newer drugs:

    Atazanavir (Reyataz) An adult may take 2 of the 150 mg per day. That’s $ 699.49/60 or $ 12 each, $ 24/day.

    Tenofovir (Viread) 300mg, $ 564.29/30 or $ 19 each. You take one a day.

    Efavirenz (Sustiva) 600 mg = $ 467.35/30. One per day = $ 16.

    Abacavir (Ziagen) 300 mg = $ 434.83/60. Two per day = $ 15.

    Raltegravir (Isentress) 400 mg = $ 854.55/60. Two per day = $ 28.

    Maraviroc (Celsentri) 300 mg = $ 1044.45/60. Two per day = $ 35.

    Darunavir (Prezista). If you are a treatment experienced patient, the recommendation is 600 mg twice a day. $ 948.81 per 60 tablets or $ 32 per day. If you are treatment naive, you take 400 mg twice a day, $ 667.25/60 or $ 22/day.

    Finally, enfuvirtide (Fuzeon) injection. $ 2517 for 60 vials. You take two a day at a cost of $ 82.

    HIV is a slippery retrovirus, so you have to take combinations of drugs. I’m kind of tired and don’t feel like tackling the costs of the common combinations right now.

    There are more expensive drugs, like the new biological agents for autoimmune disorders that cost thousands of dollars a shot, cancer drugs, or peg-interferon/ribaviron for Hep C. But I think we can agree these costs are high. Particularly when you consider that treatment is life-long.

  23. ^ I have a family member who is HIV positive. His monthly bill, after all is said and done, is around $800. I always stir the pot because I don’t believe that my tax dollars should help pay for the side effects of his risky, careless sexual behavior.

  24. Quill says:

    Oh, Skeppy! The only thing worse than precious, sacred tax dollars going to something you don’t approve of is antiquated prejudice and sanctimonious moralizing.

    Dixie Carter as Julia Sugarbaker on the tv show “Designing Women” demolished those tacky, fallacy-full sentiments over 25 years ago. Get with the times. :-)

    http://www.youtube.com/watch?v=cNeh3FeU9-M

  25. mobilis says:

    The contract price to the South African government (until December 2012) amounts to – on average – about ZAR115 (USD13.29, as at today’s exchange rates) per patient per month for the standard triple combination of tenofovir (TDF), lamivudine (3TC) and efavirenz (EFV). Obviously there are also distribution and dispensing costs.

  26. mobilis says:

    Coincidentally, the following appeared in today’s newspaper -

    http://www.bdlive.co.za/business/healthcare/2012/10/12/drug-firms-get-ready-to-bid-for-states-new-aids-tender

    Back of envelope calculations suggest the cost of ARVs per patient per month for the period 2012-2014 is likely to be between ZAR150 and ZAR330 – USD17.40 and USD 38.28 respectively.

  27. kathy says:

    Windriven wrote: “Interestingly South Africa, with a per capita GDP 20 times that of Zimbabwe actually has a larger fraction of its population living with AIDS than does Zimbabwe (17.8% v. 14.3% but either number is knee-shaking scary).”

    You need to be careful of these numbers, as of any estimate. In neither country is medical coverage complete, and a lot of people live and die without seeing a doctor or a hospital. The sheer logistical difficulties, and expense, of getting to a clinic or a doctor are hard to appreciate unless you live in Africa as I do.

    Even those that do die in hospital or under a doctor’s care are often, for the sake of their family, not registered as having died from AIDS, but from tuberculosis, cancer, or whatever. There is still a major stigma attached. So they never get into the AIDS statistics.

    I would also be wary of figures reported by countries like Iran, that have a strong religious/political stake in presenting themselves as free of sexual “misconduct”. I doubt they are accurate, not only for the sake of the families, but for the image of the governments concerned. There are many ways to falsify stats as we all know well!

  28. BillyJoe says:

    SH,

    “I don’t believe that my tax dollars should help pay for the side effects of his risky, careless sexual behavior.”

    :)

    Well, I suppose you were only stirring the pot. But of course, as you no doubt already know, the purpose of covering the cost of his treatment is to make it less likely that his “risky careless sexual behaviour” does not lead to exponential increase in the number of cases of HIV.

  29. mousethatroared says:

    Pharmavixen and others- You aren’t really suggesting that denying treatment to HIV patients would be better for a countries economy, are you?

  30. mousethatroared says:

    sorry, editing error, that last question was for PharmaVixen* only.

    *Who I will probably start addressing as PV since my Midwestern upbringing makes me uncomfortable calling anyone “Vixen”. :)

  31. pharmavixen says:

    lol, MTR :)

    Just to clarify: my initial post points to the short-sighted motivations of psychopaths. A robust health care system is vital for continued economic growth.

    @ mobilis: this comparison of costs is very interesting! For the last 15 years I have been aghast at the cost of antiretrovirals in my country (Canada) and have been suspicious of the vague justifications offered by the pharmaceutical companies.

  32. mousethatroared says:

    @BillyJoe – well there is also the question of how a government agency is going to make decisions on how to refuse payments on treatments for HIV acquired through “risky sexual behavior” as opposed to ‘safe’? sexual behavior or accidental transmission of other kinds. Maybe they could put it on the application form.

    ‘Can your illness in anyway be interpreted to have been caused by your actions? An answer of yes will result in non-payment of government benifits.’

    And then we can send a similar form to all the American corporations that accept government funds.

    I wonder which would save more money?

  33. mousethatroared says:

    PharmaVixen – Okay, that’s what I thought, thanks for clarifying.

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