The ever-changing rules of the game don't apply to Africa 20 July 2003
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David Rasnick,
Visiting Scholar, Dept. MCB
UC Berkeley, Berkeley, CA 94720

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Re: The ever-changing rules of the game don't apply to Africa

Dear Editor,

Peter Flegg says that this is what we need to know about "the current state of play regarding HIV drugs":

"With respect to therapy with the presently available antiretroviral drugs, there is clear evidence that in asymptomatic HIV infection the balance of the risk/benefit equation is in favour of no treatment (or a deferral of treatment), while in symptomatic/advanced HIV infection the balance of the risk/benefit equation strongly favours treatment."

As Flegg let slip, Anti-HIV therapy truly is a game. Remember when the best advice representing the standard of care was "hit early, hit hard"? It wasn't that long ago. Nevertheless, if one accepts Flegg's current rules of the game, they certainly do not apply to Africa.

We read in the New York Times and numerous scientific/medical journals that Africa has 30+ million HIV positive people. However, by 2001, the WHO reported that Africa had generated a cumulative total of only 1,093,522 AIDS cases (1) (Table 1 Cumulative number of reported AIDS cases as of 25 November 2001). But, during the first two decades of AIDS, the population of Sub- Saharan Africa had grown (at an annual rate of about 2.6% per year) from 378 million in 1980 to 652 million in 2000 (2). Even if all 1.09 million died, the loss would be dwarfed by the overwhelming, simultaneous gain of 274 million people in a single generation (the equivalent of the population of the USA). To complicate Flegg's decision as to whether nor not to treat AIDS cases in Africa with the admittedly toxic anti-HIV drugs, there is no way to distinguish the African AIDS-defining diseases from conventional African morbidity and mortality since they are identical.

If one uses the best statistics available from the WHO cited above, then over 95% of HIV positive Africans are asymptomatic and should not be given the anti-HIV drugs according to Flegg's current rules of the game. In spite of the fact that there is no evidence that AIDS is devastating and depopulating Africa, the USA and other developed countries are charging ahead with their scheme to transfer tens of billions of taxpayers' dollars into the bank accounts of large pharmaceutical companies by putting anti-HIV drugs into African bodies.

Immediately, Flegg will object that AIDS is killing more people in Africa each year than the WHO's cumulative total of African AIDS cases. However, Flegg's AIDS deaths exist only in the computer models in Geneva, Washington DC, and Atlanta Georgia. This is also true for the 30+ million HIV-positive Africans. There are no actual statistics of real AIDS cases and AIDS deaths in Africa, certainly not in South Africa, which is the richest country in Sub- Saharan Africa with the best statistics.

David Rasnick

Member of Mbeki's AIDS Advisory Panel

1. World Health Organization. (2001) Global situation of the HIV/ AIDS pandemic, end 2001 Part I, Weekly epidemiological record 76, 381-384

2. U.S. Bureau of the Census International Data Base. (2001) World population by region and development category: 1950- 2025, Washington, DC, U.S. Department of Commerce, Bureau of the Census, March, 1999,

Competing interests:   None declared