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Charles Geshekter challenges Nicoli Nattrass



Nicoli Nattrass was author of a conference "AIDS, Science and Governance: The Battle Over Antiretroviral Therapy in Post-Apartheid South Africa" at a conference at York University in Toronto in May, 2006. She was also co-author, with John Moore, of a June 2006 Op-Ed in the New York Times entitled "Deadly Quackery". This stimulated the following exchange with Charles Geshekter.

CG June 16th

Dear Nicoli:
A few months ago we briefly corresponded.
I have now finished your fascinating paper on “AIDS, Science and Governance: The Battle Over Antiretroviral Therapy in Post-Apartheid South Africa,” which you presented at York University in March this year.
As an economic historian of Africa, I welcome a lively exchange of ideas, information, perspectives, and data on this vitally important topic. Because you cite a physician colleague of mine, Sam Mhlongo, in your paper, I have taken the liberty to copy him here.
You will discern from the outset that I strongly disagree with most of your central assumptions. But in the spirit of intellectual exchange, I hope you will agree that we can only achieve a measure of the truth about AIDS when we academically rub up against each other.
Mine is just a rather lengthy email after all, so in that spirit here are my comments on your own 25-page paper. Some of my comments are in reaction to your claims about antiretroviral drugs, but the bulk of my response deals with some basic facts about history, economics and common sense in South Africa.
I was surprised at your often shrill condescension towards anyone who dares to question or dissent from the AIDS orthodoxy. And yet your own uncritical stance towards antiretroviral drugs seems based on the assumption that we can prescribe a pill for every ill. That seems to ignore how decidedly anti-female, patronizing, and paternalistic the entire orthodox regimen of treatment is towards women.
As far as I know, there are no such things as “anti-viral” drugs because there is no way to inhibit the virus without also simultaneously inhibiting cellular growth. The term HIV describes a collection of non-specific, cross-reactive cellular material. HIV tests are not standardized, but are arbitrarily interpreted by different laboratories. Because HIV tests are antibody tests, they produce many false-positive results. This is crucial to keep in mind whenever one reads about statistical rates or percentages of HIV cases in any population group.
All antibodies tend to cross-react. Humans constantly produce antibodies in response to stress, malnutrition, drug use, vaccination, certain foods, a cut, a cold, intestinal worms, tuberculosis, or even pregnancy. All of these antibodies are known to make HIV tests come up as positive.
The packet insert in an HIV/ELISA test from Abbott Laboratories contains this prudent disclaimer: “At present there is no recognized standard for establishing the presence or absence of antibodies to HIV-1 in human blood.” Yet the cornerstone surveillance study for HIV seroprevalence in Africa, as you well know, rests on administering a single ELISA test to pregnant (almost entirely African) women attending antenatal clinics, never acknowledging that the ELISA test is notoriously unreliable in those circumstances since pregnancy is one of numerous conditions known to elicit a “false positive” result.
The kinetics of viral replication means that viruses replicate themselves in 8-24 hours and generate 1000 new viruses per cell. That means that within about 6-7 days they have infected 100 trillion cells! The body generates anti-viral immunity within 1-4 weeks but with AIDS you apparently believe that this takes 250-500 weeks. How is that possible? Especially when one finds no active AIDS virus in AIDS patients, only the antibodies against it?
Can you explain how a retrovirus that is found in, at the most, one in 500-750 cells in patients nearing death can possibly be the cause of their demise? Why would you imagine that sexual activity has got anything to do with HIV rates, AIDS cases, or the appearance of the widespread clinical symptoms that define an AIDS case in Africa.
I was truly disheartened by your complimentary remarks about that virulent chemical AZT, a dusted off chemotherapy treatment whose effects are that of a random DNA chain terminator and whose allegedly “beneficial” results were scientifically questioned and denied back in the early 90s. The so-called “toxic side-effects” of AZT are its effects, not so-called “reduced transmission of HIV.”
I know many gay brothers in the San Francisco area who admit to being alive today precisely because they <b>stopped</b> taking that virulently toxic, life-shortening drug.
Can you honestly look me in the email eye and tell me that you do not know that AZT is an immunotoxic, neurotoxic and carcinogenic drug? Why on earth would any professional woman advocate giving such a poison to pregnant women?
I thought the embrace of AZT had been long ago relegated to fringe true believers but now you cite a local zoologist (!) Michael Cherry about AZT. You gotta do better than that, Nicoli.
I am astounded that an economist overlooks the barren explanatory power of the infectious viral hypothesis of AIDS causation or never notices how the AIDS orthodoxy clings to its claims with a religious tenacity and an absolutist set of convictions reminiscent of medieval ecclesiastics.
Many years ago, it become apparent to me that those intent on “fighting AIDS” in South Africa had adopted a missionary-style crusade, evidently similar to “fighting apartheid” in the minds of many activists whose lives (like Zackie and the TAC crowd) seemed devoted to a permanent campaign of some sort. Their reliance on military metaphors, apocalyptic visions, and withering scorn toward any disagreement reflected a zealotry that brooked no opposition.
Outside the Durban Conference Center at the 2000 International AIDS Conference, enraged and bewildered demonstrators held signs that advocated, “one dissident, one bullet,” neatly capturing the anti-science demagoguery of AIDS activists. You remember that scene, right?
Contrary to what you claim, the AIDS orthodoxy has long stifled what ought to have been a lively, inclusive debate on issues ranging from statistics and epidemiology to science, economic history, and notions about African sexuality. Averse to second thoughts and unable to be self-critical, such messiahs-with-a-program instead contend that anyone who questions their core beliefs or challenges the infectious viral theory of AIDS is not merely an honorable scholar with different views, but is someone who commits great evil.
This is not something they can prove or explain rationally – it is simply an article of faith.
And yet you claim with a straight face that the AIDS orthodoxy’s assumption are a “respected elite body of knowledge subject to constant and critical examination.” Come on now Nicoli, you know better than that. To me, any theory in science is a structure of related ideas that explains one or more natural phenomena and is supported by observations from the natural world. It is not something less than a fact.
Let’s apply all of this to South African history over the past 50 years. You seem convinced that death rates or actual fatalities in South Africa between 1995 and 2004 can be attributed to “AIDS” cases. You really need to strengthen your grasp of South African history. Do you need me to remind you that South Africa itself was juridically defined differently in 1989 than 1999? This elementary distinction is one I thought an economist would spot at once.
You claim that the “causes-of-death studies” (p. 14) are an important factual point and that “AIDS deaths by age and gender have been rising in line with what we would expect given HIV prevalence data over time” (p. 14). What can this possibly mean, based on the epidemiological and historical data in front of you?
Herein lies the central fatal flaw of your entire analysis. You cannot admit that these HIV rates are so skewed because they are based on sentinel studies done at antenatal clinics then extrapolated to the larger South African population.
All I’m saying is that a thorough historical treatment can yield demystifying results when examining AIDS in South Africa. Alert to the historical discontinuities in that country before and after 1989, that review must recognize that any comparative statistical analysis designed to show which illnesses now afflict South Africans and which ones formerly were the causes of death must be acutely sensitive to how the <i>definition</i> of what constituted “South Africa” dramatically changed between 1989 and 1999.
Look - in 1989, South Africa was said, according to its official government terminology, to have a total population of about 21 million. But this figure consciously excluded the 6.1 million Africans who lived in the so-called TBVC states (Transkei, Bophuthatswana, Venda and Ciskei), which comprised 100,000 square kilometers. Furthermore, “South Africa” as defined in 1989 excluded another 8.2 million people who lived in the six “self-governing territories” (SGTs) that comprised a further 67,000 square kilometers.
The overwhelming majority of these 14.3 million Africans living in those fragmented territories were the most obvious victims of white supremacist apartheid. The huge rural slums of the TBVC countries were “urban” with respect to population density but were “rural” with regard to the absence of proper infrastructure or services, especially in terms of public health.
The 1989 study by Wilson and Ramphele, <i>Uprooting Poverty: The South African Challenge</i> analyzed the depths of poverty which they showed were caused by “insufficient labour, insufficient capital and the high risk of much toil yielding little fruit.” In many cases, they explained that “people are too poor to farm; they cannot afford protective fencing or even to buy seed and fertilizer. Tractors may be too expensive to hire and oxen to weak to plough.”
The statistical reporting for any aspect of health, employment and living conditions among those 14.3 million Africans was fragmented and systematically evasive. But would you dispute that mortality and morbidity rates were significantly higher in the TBVC countries and the SGTs than in the rest of South Africa? People in those areas suffered from far greater rates of protein anemia, malaria, tuberculosis, cholera and dysentery and that life expectancy was significantly lower there than in the rest of South Africa, as defined in 1989. Correct?
So then let’s imagine what happened when vital statistics on those 14.3 million people (who probably now number at least 17 million) were added for inclusion in post-apartheid, unitary South Africa? Today, the impoverished inhabitants of those former rural slums are citizens of a single South Africa.
No matter what William Makgoba may fervently believe, as a non-historian, their addition to public health statistics reveals a great deal about the unhealthy living conditions that had long prevailed in the TBVC and SGT areas under the <i>apartheid</i> regime, not the transmissibility of some mutant retrovirus from the Congolese rainforest spread by truck drivers and prostitutes. Remember Occam’s Razor?
Many places in KwaZulu-Natal that today correspond to the former Bantustans or the Self-Governing Territory of KwaZulu were rural slums and cesspools of poverty, ignorance and disease in the pre-1991 period. Researchers who claim otherwise should provide mortality and morbidity statistics for KwaZulu, Transkei, Ciskei, and Venda for 1980 and 1985 to assure independent verification. Perhaps Makgoba can help you provide me with those crucial numbers.
Makgoba claims that his “greatest love and passion for scientific research is its creative sprit, its detached reflective perspective, its power to assault ignorance and its autonomy.”
I agree entirely. But it is only by using those time-honored tools that one can begin to break down the colossal chain of errors that lies at the heart of your belief that some sexually-transmitted retrovirus from the rainforest, spread from chimps to humans, is what explains sickness, ill health and death among people anywhere in Africa.
I toured large areas of South Africa in 1999 and 2000 (KwaZulu-Natal, Maputaland, eastern Cape, and western Cape), then compared what I saw and heard there to what I heard in northern Somalia (Somaliland) when I travelled there in 2001. People are ill with malaria, TB, protein anemia, a variety of respiratory illnesses, and a variety of injuries from physical assaults and accidents.
If AIDS is somehow caused by sexual activity then we should find rampant cases among the overtly sexually-besotted subcultures of the north Durban beaches, the affluent north Jo’Burg suburbs or the international swinger scenes around Sea Point and Camps Bay not far from where you live. Okay?
For instance, despite somber insinuations that Africans are unwilling to discuss their sexual practices, in my experience every time I sought to critically review the literature on sexuality, it was the AIDS researchers themselves who quickly ended the conversation.
AIDS has become a great diversion. The belief that behavior modification will cure poverty overlooks the endemic conditions that cause the appearance of the “symptoms” in the first place. AIDS researchers ignore the historical forces that propelled many parts of Africa into a downward economic spiral beginning in the late 1970s and set the stage for the appearance of “AIDS.”
As you well know, during the early 1980s, a “Washington Consensus” dominated official thinking about economic development in the U.S. government, the IMF, the World Bank and private banks and foundations. It called for sharp cutbacks in government spending, financial liberalization, privatization of state-owned enterprises, deregulation and the supremacy of the market over all other values, policies that contributed mightily to the demise of Africa.
According to Joseph Stiglitz, an economist formerly with the World Bank, during the 1990s, the number of people living in extreme poverty (less than $2 per day) increased by nearly 100 million, world-wide, with the disproportionate amount being found in Africa.
In his Presidential address at the 2005 meeting of the African Studies Association in Washington, historian Bruce Berman delineated distinctive African experiences with modernization to show how “the current epoch of globalization” had produced “profound immiseration, social decay, state failure and acute vulnerabilityS” Berman recalled how the “exhilarating days of independence in the 1960s and into the 1970s” gave way in the early 1980s to “extreme economic decline” whereby a “large proportion of the population of Africa [was] reduced, in the chilling Victorian word, to a social ‘residuum’ effectively expelled from the global market.” Much of this would apply with devastating accuracy to the cesspools of poverty, ignorance, and despair that characterized rural African lives in apartheid-era South Africa. Anything here you disagree with?
By the late 1970s, the post-colonial narrative of modernization, economic development, and nation-building began to collapse. Countries in eastern and southern Africa became so indebted to and dependent on international financial institutions that they were no longer free to make basic decisions about which goods and services could be allocated.
Over the past 30 years, as world prices for key African agricultural exports stagnated, that continent was the only one where people became materially poorer. Beginning in the early 1980s, corruption and decay in the public health field, sharp decreases in the prices of exported commodities, severe restrictions on social services due to the IMF and World Bank strictures of structural adjustment, savage civil wars, declining rates of immunization, and crowded refugee camps were among the major forces afflicting Africa as the 20<sup>th</sup> century ended. <b>None of these historical forces were related to sexual promiscuity</b>.
Instead of stubbornly promoting a “pill for every ill,” why not read for yourself what the WHO says in its very own 2002 booklet, “Living Well With HIV/AIDS: A Manual in Nutritional Care and Support for People Living With HIV/AIDS.” Its sound, solid, practical and non-controversial advice would apply equally to EVERYONE, by the way.
Its sensible recommendations both mirror or anticipate the down-to-earth and sensible recommendations of medical bedside manners around the world - ask the patient what is bothering him/her, prescribe something to help alleviate the clinical symptoms (not some surrogate markers), then have the patient return and answer the question, “how are you doing?” Above all, provide adequate, balanced nourishment…
There is no “African Solution” to AIDS any more than there is a “western solution.” There are only sound, replicable studies and interventions versus flawed and preconceived ones. Not CD4 cell counts or viral loads <b>but clinical endpoint studies</b>. Would you please cite me the best three such studies that you have read in, say, the past three years regarding AIDS patients?
You seem aggressive in your pursuit of charlatans without appreciating how the derivative and uncreative AIDS industry in South Africa has been largely responsible for terrorizing, misleading and deceiving people into thinking that their weight loss, diarrhea, fevers or persistent coughs (or when seen in loved ones) are caused by some sexual activity they had, thereby impelling them to appeal to witchdoctors, diviners or other such healers for help.
What about applying your same crusading zeal to the fact that claims that safe sex is the only way to avoid AIDS inadvertently scares Africans from visiting public health clinics for fear of receiving an AIDS diagnosis?
A Lancet study showed that even Africans “with treatable medical conditions (such as tuberculosis) who perceive themselves as having HIV infection fail to seek medical attention because they think that they have an untreatable disease.” Biomedical funds that used to fight malaria, tuberculosis and leprosy are now diverted into sex counseling and condom distribution, while social scientists obsess over behavior modification programs and AIDS awareness surveys.
One of the worst such examples was that Summertown HIV-Prevention Project which lasted three years in an impoverished township outside Cape Town. Remember that study?
It was described as a “mixed bag of disappointments and achievementsS[as] many proposed activities [were] yet to be implemented, consistent and widespread condom use remains lowSand the most damning lack of Project success over the three-year research period is the lack of evidence for any reduction in STI [sexually transmitted infection] levels.”
The analysis by its Director used such impenetrable prose that I was not surprised by the Project’s admitted lack of effect on either sexual behavior, HIV rates, or AIDS cases. As Campbell states in her conclusion:
”In the interests of contributing to the development of a critical social psychology of sexuality, the research has illustrated the way in which sexual behaviour, and the possibility of sexual behaviour change, are determined by an interlocking series of multi-level processes, which are often not under the control of an individual person’s rational conscious choice. Sexualities are constructed and reconstructed at the intersection of a kaleidoscopic array of interlocking multi-level processes, ranging from the intra-psychological to the macro-social.”
God help us when AIDS education degenerates to this level of obscurantist jargon and overt obfuscation!
The researchers of the Summertown Project honestly believed that sexual behavior changes would make poor South Africans unsick and enable them to stay well. They never imagined that their project failed because its core construct was erroneous and incapable of correction. I doubt that they ever considered that the production of HIV antibodies was environmentally induced, and had little or nothing to do with sexuality. Their sincere interventions and complex proposals were wholly inadequate for the task of sexual behavior modification.
In my view, that Project is a valuable example of how not to proceed with AIDS education and awareness. What is your take on it, Nicoli?
I have often wondered how sexuality that is essential for the reproduction of our species came to be perceived as dangerous to one’s health. I would have though that the absence of normal sexual activities would be injurious to one’s health. But never mind. And how is breast-feeding also now deemed dangerous to health but giving drugs is life-enhancing?
By the way, just out of curiosity, what is your own personal set of values about sexuality in modern life? Is it something that you actively engage in freely and happily with good results or is it something that repels you, makes you ill, and which you engage in rarely or not at all?
If you imagine that these are somehow inappropriate questions to ask a perfect stranger then I suggest you also withhold your judgments and comments about the actual cause of someone’s death - a far more serious matter than who’s sleeping with whom! - and about which you have no access to medical records like the ones you cite in your paper.
Your three paragraph conclusion (p. 25) is arguably the place where I would most strongly disagree with you. The religious zealotry with which the infectious viral theory of AIDS is pursued by advocates like you is what has eroded the authority of science. Do not blame that on President Mbeki or his sensible and economical queries. The flaws, dishonesty and deceptions that characterically marred the early history of AIDS cases here in California are the root causes for arousing doubts and raising healthy second thoughts.
The way that members of the AIDS orthodoxy bitterly avoid these debates and instead lampoon and censor their critics are further signs of a paradigm in full-blown denial of its own convoluted history.
After reading your final paragraph, with its bombastic claim that questioning the viral hypothesis of AIDS or doubting the effectiveness of known toxic therapies somehow threatens lives, I have three questions for you.
First, whom shall we assign the blame for a generation of American gay men who died due to AZT?
Second, who will take responsibility for the many thousands of Africans and Americans who committed suicide when given the results of an antibody test known by its manufacturer NOT to detect viral particles in human blood?
Third, why do these basic issues arouse such virulent and abusive charges from those who adhere to the infectious viral hypothesis of AIDS?
It will be with pleasure and academic interest that I await your replies.
Sincerely yours,
Charles Geshekter
California State University, Chico
Chico, California 95929

NN June 17th

Dear Charles,
You need to make more of an effort to get up to speed with the science of AIDS and of antiretroviral treatment. I suggest you take a look at the useful summaries and recent articles posted on:
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I also recommend, given the ridiculous statements you make about the HIV test, that you make a special effort to get to grips with the basic science of HIV testing:
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Furthermore, if you want to understand how the ASSA model is able to reconcile the rise in deaths by age and gender with what we know from sentinal survey sites - and produce HIV prevalence rates that are in line with national survey data, then I suggest you take a look at the ASSA model and accompanying guides:
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I recently taught the model to a group of Yale undergraduates, so hopefully you should manage....
So, you are an economic historian of Africa, are you? I will believe you, despite the fact that I couldn’t find much evidence for that on Google Scholar. But, even so, I was wondering what you made of Iliffe’s recent book: The African AIDS Epidemic: A History. John Iliffe is, after all, the most eminent African historian alive today. Do you think he is part of your imagined vast conspiracy between epidemiologists, virologists, immunologists, clinicians, social scientists and historians to invent a virus and an epidemic which really doesnt exist?.
Nicoli Nattrass

CG June 17th

Dear Nicoli:
Just as I predicted, you simply dodged all the key historical and economics questions about South Africa that I posed to you, preferring instead to lazily type in a variety of website addresses.
Thanks for reaffirming the academic fears and intellectual sloth that so characterize members of the AIDS-is-everywhere orthodoxy.
You must be pretty busy as a front line fighter against the AIDS plague, eh? Safe sex, condomize the continent, empower women to negotiate sex…that’ll save the Rainbow Nation all right.
But nary a word about that errant and deplorable Summertown Project. Cat got yer tongue, Nicoli? I can’t blame you for wanting to distance yourself from that squandering of time, effort and money.
I recall that 20 years ago many white South Africans used to complain that Africans “were breeding like flies.” Nowadays, the same folks are lamenting that Africans “are dying like flies.” I know that I can safely exclude you from those racist groups, correct?
Your imagination about my belief in some vast conspiracy is hilarious. Is that how members of your Church of Establishment AIDS Orthodoxy think? Look, let’s be candid - your March 2006 paper was a hodge-podge of errors, faux definitions, ahistorical nonsense and a cartoonish use of political cartoons.
Unlike the doting admirers with whom you associate, I was the bearer of unpleasant facts, so I can’t blame you for lashing out at me. Doesn’t sound like you learned very much about academic debate during your stint at New Haven. Lots of timid, obedient, adoring undergrads, eh? You must have been in heaven.
I would be thrilled to disembowel John Iliffe’s latest book any time. But perhaps we should first start with his most illuminating study of East African doctors that unwittingly provided a mountain of rich evidence that unwittingly and unintentionally supports my own take on the “AIDS-in-Africa.” Shall we look at that book first?
Speaking of new books, have you read that fine new book by fellow economist Eileen Stillwaggon? Indispensable reading for any discussion about HIV and AIDS in Africa (especially given the barrage of ahistorical trash and statistical sophistry about South Africa that you embrace) is her <i>AIDS and the Ecology of Poverty</i> (New York: Oxford University Press, 2006).
One of its finest parts is Chapter 7, “Racial Metaphors: Interpreting Sex and AIDS in Africa.” The most important thread of that chapter is Stillwaggon’s sober and meticulous denouement of the errant and abhorrent research claims made by John and Pat Caldwell. Stillwaggon exposes the racist claptrap and utterly distorted observations that characterize the claims of those two, oft-cited mainstream AIDS researchers about African sexual behavior.
I’m positive that a smart cookie like you probably long ago distanced herself from the vapid, Victorian moralizing of the Caldwells.
Keep up your heroic work, enjoy your international travels, continue on your merry way dodging and ignoring even the most elementary questions about the political economy and history of South Africa, two areas that you obviously and painfully know nothing about.
Iliffe and Stillwaggon? Just give me the word.
Warm regards, Charles Geshekter

NN June 17th

Thanks for sending that article - it certainly does seem on first sight to be counter-intuitive (as you probably know from my book, The Moral Economy of AIDS, I, like Stillwaggon think that poor people are especially vulnerable to HIV). I agree with you that it would have been better if the study had included South Africa. Anyway, I suspect that the apparent confusion has to do with the fact that the report is talking about relative poverty when Stillwaggon etc make the case that it is absolute poverty that is the problem. Certainly looking at the Lesotho data, most people are absolutely poor - so the relative rankings are probably moot. Nevertheless, I will only be able to assess the report once I read it myself.

CG June 17th

Dear Nicoli:

Whilst awaiting a reply from my last email to you, I noticed this latest blockbuster announcement, carried in the Boston Globe:

As a front line AIDS researcher, what was your take on this startling report?

I know that you’re a real stickler for documentation, just like me, so I was wondering why the researchers in this latest survey failed to include wealthy white South Africans whose embrace of a widely ranging sexuality is obvious to anyone who visits the country (like me) or who lives there (like you)?

I remember a study of Kenyan prostitutes about 10 years ago that suggested that having unprotected sex seemed to give them immunity or protection against HIV in ways that abstention did not.

That old AIDS virus, despite its remarkably uncomplicated genome, is incredibly smarter and wilier than even the best brains engaged in AIDS research. How do you explain that?

Perhaps your partner John Moore can help decipher all this mysterious African AIDS stuff?

Best regards,
Charles Geshekter

CG June 19th

Dear Nicoli:
I have copied our email exchange to Sam Mhlongo, M.D.
That’s because you disparagingly referred to him in the March 2006 paper that you delivered at York University and which formed the basis for my criticisms of the methodological weaknesses and glaring lacunae demonstrated in that effort.
Like nearly all adherents to the infectious viral hypothesis of AIDS, you congenitally deny the convoluted, error-filled and deadly history of your field of specialization.
What the hell - if I were in your position, I too would probably lash out with venom and scorn at any who dared challenge the core construct of your flawed and deceptive view of what’s making Africans ill and cling desperately to your orthodoxy denialism, like someone clinging to rocks at the bottom of a river.
You proclaim that you “are not a scientist,” yet vanish from the fray or change the subject every time I pose non-scientific questions about the economic and political history of the country in which you live.
You won’t even answer the most basic questions about the “moral economy of AIDS” (the title of your book!!) versus the “moral economy of apartheid,” either because you cannot or because you know that I will hang you by your own petard if you venture into the very areas that you should know something about.
You claim that you “are not a scientist,” then resort to disputable claims about virology and chemistry while ignoring your very own field and mine - economic and history.
You dare not engage me in an open conversation about the contents of Stillwaggon’s book, you cannot discuss the past 50 years of South African history, and you must not consider the “counter-intuitive” findings of Nancy Padian or Catherine Campbell.
Any of these topics in public health, racist behavioral modification schemes, hoary and offensive claims about black people’s sexuality, and antiquated takes on South African history would only expose the mentality of taboo that so mars (nay, characterizes) your entire social construct of what’s making people sick and how they can get well.
Your psychological projections onto your critics of your own weaknesses are breathtaking. Hence your wholesale embrace of a spooky denialism towards the inconsistencies, flaw, errors, and deadly advice proffered to unsuspecting victims of the AIDS Industry is what makes your entire enterprise so vapid, empty and counter-productive.
Others within your self-serving and self-anointed clerisy of AIDS orthodox church members will be tres impressed and awed by your self- serving duties and responsibilities. I am impressed by your mental agility in dodging economics and historical topics and wowed by your stubborn refusal to engage, as a non-scientist, in non-scientific topics.
Thus, let someone pose elementary questions about your own field - economics in South Africa - or about the history of the country in which you live, and you tremble with scorn, react with haughty pretension, or huff-&-puff about your other duties.
Okay, okay Nicoli - you’ve convinced me of the importance, value and accuracy of your academic niche - now convince yourself.
Warmest regards, Charles

NN June 18th

Dear Charles (and whoever you have been copying or wish to copy on our correspondence),
It is not my job to give you one-on-one tutorials about the science of HIV and AIDS treatment, or on the substantial body of social science literature dealing with the social aspects and impact of the AIDS epidemic. John Iliffe (2006) has produced a good history of the African AIDS epidemic which draws on science, history, epidemiology and social science. I suggest you read it (reference listed below).
Illife, along with all serious scholars of the African AIDS epidemic, appreciates the role of poverty, gender, history and other contextual factors – but unlike you, does not reject the orthodox science of HIV testing and AIDS treatment. I am not a scientist, so it is inappropriate for me to debate you, or anyone else, on these matters. I am, however, aware that enormous scientific advances have taken place in this field – especially in the past few years. I suggest you start reading the scientific literature and stop reproducing arguments that are almost two decades old. We now know a lot more about how HIV undermines the immune system and why, for genetic reasons, some people are more susceptible to the virus than others. For useful summaries of AIDS science and recent academic articles see:
We have also learned that antiretrovirals (for all their limitations and side effects) extend life significantly. For two recent papers, see Walensky et al (2006) and Smit et al (2006) – references and weblinks provided below. But while there are treatment options for people living with AIDS, preventing HIV infection in the first place ought to be a key policy focus. In Africa, where I live and work, mother to child transmission prevention (MTCTP) is very important. A recent study from Uganda showed that most infants infected by their mothers died before the age of two (Heena et al, 2006). A short course of antiretroviral treatment reduces HIV transmission substantially, saves lives and is cost-effective (see Chapter 3 of Nattrass, 2004).
People like you, who in the face of substantial evidence to the contrary, continue to promote views which undermine HIV prevention and treatment interventions, are a threat to public health. Please do the necessary homework – and please do not bother me any more over the email. I have real students and peer-reviewed research to attend to.
Yours sincerely,
Dr Nicoli Nattrass (Professor in the School of Economics and Director of the AIDS and Society Research Unit, University of Cape Town).
Heena, B., Godfrey, M., Wabwire-Mangen, F., Serwadda, D., Lutalo, T., Nalugoda, F., Sewankambo, N., Kiduggavu, M., Wawer, M. and R. Gray. 2006. “Mortality in HIV-Infected and Uninfected Children of HIV-Infected and Uninfected Mothers in Rural Uganda”, in Journal of AIDS, vol.41, no.4: 504-508. Available on: 00126334-200604010-00015.htm;jsessionid=GT2TyHNJQ5ySBgVWGkmcTQxhPsG8nW h4x2FnzyQnkgjc1PnDLZf0!588122478!-949856145!8091!-1? index=1&database=ppvovft&results=1&count=10&searchid=1&nav=search
Illife, J. 2006. The African AIDS Epidemic: A History, Ohio University Press (Athens) and James Currey (Oxford).
Nattrass, N. 2004. The Moral Economy of AIDS in South Africa, Cambridge University Press, Cambridge.
Smit, G., Geskus, R., Walker, S., Sabin, C., Couthino, R., Porter, K., Prins, M., and the CASCADE Collaboration. 2006. “Effective Therapy has Altered the Spectrum of Cause-Specific Mortality following HIV Serocoversion”, in AIDS, 20(50):741-9, March 21. cmd=Retrieve&db=PubMed&list_uids=16514305&dopt=Abstract)
Walensky, R., Paltiel, D, Losina, E., Mercincavage, L, Achackman, B., Sax, P., Weinstein, M., and Freedberg, K. 2006. “The Survival Benefits of AIDS Treatment in the United States”, in Journal of Infectious Diseases, 2006: 194: 11-19. v194n1/35845/35845.html?erFrom=1051591522556139046Guest

CG June 19th

Dear Nicoli:
So sorry to distract you from your hard work giving safe sex lectures, promoting toxic drugs for vulnerable pregnant women, poring over undergrad exams, or the many other acts of heroism you do to battle the infernal AIDS plague/pandemic/forestfire/scourge/holocaust…but take a look at this sober, sensible, common sense explanation in your own field – economics! – about why Africans have grown increasingly ill over the past 25 years.
This must have been made up! Can any of this really be true?
But wait a sec – lookie here – …no fairy takes about mutant rainforest retroviruses, fanciful myths about Africans using or eating monkey blood or chimp meat, racist hyperbole about the strange sexual practices of the natives, no reference to truck drivers and prostitutes, or pleas to condomize the continent, or any of the other hilarious claims that characterize the AIDS-is-everywhere mantra…just a calm, sober, straightforward dissection of economics, trade, and investment policies over the past 25 plus years.
I would betcha that these were the real co-factors behind the increased number of Africans with weight loss, high fevers, persistent coughs, and chronic diarrhea. Whattya bet?
It’s almost enough to make you junk this AIDS rubbish and return to solid economics studies, eh?
Well, okay, probably not enough because the pay, acclaim, and status won’t be nearly as good.
Yours in struggle, with warm regards,
Charles (in California)
PS - let me know when you’d like to discuss the history of AIDS in California…

Meshack Owino

                           Meshack Owino
In one of his most memorable speeches as the president of the United States, Ronald Reagan talked about a man who kept telling his bride how he was going to give her the best experience in bed she had ever had. The whole night the man kept telling his bride how good he was going to make her feel - while sitting by her bedside. Night turned into days and days into years, and the man was still talking, promising the bride how good it was going to be. Ronald Reagan concluded his misogynistic speech by asserting that he was actually referring to the Democratic Party, and not to a real man; the Democratic Party, he claimed, was all talk but no action, it had a penchant for promising Americans a change for the better without delivering. This was the speech that leapt into my mind immediately I read an article by Rodrigo de Rato in the Daily Nation newspaper of Kenya, Friday, May 12, 2006, telling Africans how IMF policies were going to develop Africa. In the article entitled, “Building on the foundations of growth,” Mr. de Rato, who is the Managing Director of the IMF, claimed that Africa’s economy was on the road to recovery. “The benefits of economic stabilization [in Africa]” de Rato said, “are becoming increasingly visible, with the last few years witnessing growth at its highest in 30 years and inflation at its lowest in a quarter of a century.”
When one reads de Rato’ article, one notices a striking similarity between his optimism for Africa through IMF policies, and the optimistic promises Ronald Reagan said some people make to their spouses while perpetually sitting down fully clothed. One notices that, according to the IMF, development in Africa is always around the corner. It is always just about to be here and there, always about to materialize. Africa is always on the verge of economic development for the last twenty-six years. Yet the IMF keeps on talking; keeps on making promises.
Those of us who were born and brought up in Africa know that the IMF’ claims are at best empty, and at worst, cynical promises aimed at hoodwinking our people and our continent that things are about to be better. Those of us who have grown up in Africa know that contrary to de Rato’ claims, the IMF policies are shattering, rather than developing, the African continent. We know this because we see the devastation with our own eyes and experience them in our lives. Away from IMF high-sounding charts and statistics, we see how our children are daily unable to pay school fees because the IMF long-insisted on cost-sharing in education; our fathers are losing jobs because of IMF retrenchment policies; our sick are dieing in large numbers due to the lack of basic health services, with the IMF having demanded an end to free health services in government hospitals; and our poor are languishing at home, their means of livelihoods having been taken over by rapacious multinational companies in the name of liberalization of our economies.
We know where our continent was in terms of its level of development before the introduction of IMF and World Bank SAPs, and where it is right now after the implementation of those policies. We know from experience that there is a big difference between IMF claims, and the reality of stark poverty and absolute misery in our beloved continent. The last twenty six years of experimentation with IMF and World Bank policies have left our people in agony. There are high levels of unemployment, poverty, and death. Our artists, musicians, footballers, doctors, teachers, lawyers, nurses, engineers, soldiers, and so on have died either because of retrenchment, or because of failure to secure free medical services in government hospitals - thanks to IMF and World Bank policies. An incredibly high number of our people have been pushed into poverty, and millions have needlessly died because IMF and World Bank policies have prevented their governments from providing them with free medical services. But the IMF and World Bank keep on talking, promising how Africa is about to reach economic orgasm.
The withdrawal of free basic services was one of the conditions that the World Bank and IMF imposed on Africa in exchange for financial aid. Many African countries implemented IMF and Word Bank conditions (Structural Adjustment Programs [SAPs]) in the 1980’s believing that they would lead to the materialization of a nirvana that the IMF and World Bank were promising. Faithfully implementing World Bank and IMF policies, African governments retrenched their workers in the name of reducing government expenditure and increasing efficiency. They devalued their currencies, and liberalized their markets in the name of spurring development through competition with international companies. They offered tax exemptions and other incentives to mostly foreign companies in the name of attracting foreign investments and creating jobs. They introduced cost-sharing policies in social services like water, education, and health in the name of better, cheaper, and efficient services.
Yet after many years of experimentations with SAPs, none of the promised benefits has materialized; the nirvana has proved elusive. Virtually all African countries that have implemented SAPs have reaped, not the land of milk and honey promised by the IMF and World Bank, but high unemployment, extreme poverty, and unbelievable rate of death. The only groups that have been happy, laughing all the way to the banks, are foreign companies. Foreign multinational companies have virtually been able to seize control of African economies, and are greedily extracting and transferring Africa’s wealth back to their mother-countries at the expense of African people. The liberalization of African economies, the retrenchment of government employees, and the introduction of cost-sharing policies in social services have all eventuated in extreme poverty and death in Africa. The number of people living below the poverty line in Kenya, for example, has escalated and today stands at 57%, while foreign multinational companies involved in banking and finance, horticulture, health and pharmaceutical sectors, to mention a few, post obscene profits year after year.
Yet, in the middle of all these problems, IMF and World Bank officials have maintained stoic optimism, and pretended that all is well. Just like the perpetually optimistic spouse that Ronald Reagan talked about, the IMF and World Bank have continued to paint a rosy future for Africa even when empirical evidence tells a different story. It is almost as if the IMF and World Bank are in denial. For the last twenty or more years, the IMF and World Bank have sat by Africa’s bedside making promises after promises without delivering. In a few cases, the IMF and World Bank have tried to modify some of their policies with programs like the Poverty Alleviation Program, but, in general terms, they have remained faithful to the overall thrust of their policies, insisting that SAPs will eventually deliver Africa to the land of milk and honey. They will not admit failure.
Even if all African people become poor, and die, it appears that the IMF and World Bank will continue with their empty slogans. They will not bring a stop to their ruinous policies in Africa. It is up to Africans to wake up to this reality. African governments in particular must realize that they cannot afford to leave their people at the mercy of the IMF and World Bank, and their destructive policies anymore.
Meshack Owino.

© Copyright May 18, 2009 by Rethinking AIDS.