(Continued from previous page: HIV-Aids Scientific Controversy Part 1)
Although the zeal with which Western donor agencies have responded to the AIDS crisis is commendable and shows their humanitarian intentions, investing so much scarce resource into a possible misdiagnosed disease will be harmful in the long run. The numerous AIDS agencies in the field may have disruptive impacts on the social fabric of those African societies. There may actually be evidence that the donor agency campaigns and policies may be misdirected and achieving the wrong results. They may be diverting meager funding from health policies that could truly make a difference in African lives to focus on the exciting, sensational, and high profile HIV-AIDS campaign. This author warned about this possibility including a critique of what appeared at the time to be racially motivated claims that AIDS originated from Africa and was therefore spread by Africans. In the 1991 book review of Chirimuuta’s AIDS, Africa, and Racism, this author warned: “The real dangers of these persistent racially motivated claims is that too much money and effort is being devoted to fighting AIDS in Africa when too many people might be dying of malaria, malnutrition, and lack of basic health care. Secondly, when Western AIDS researchers limit themselves to racist agenda, thereby needlessly politicizing the deadly disease, they close the door to lines of investigation that might yield real solutions to the problem of AIDS”.(Tembo, 1991:373)
After close to two decades of the intensive campaign involving billions of US dollars, the possible negative impact on the African social fabric and dignity of the international HIV-AIDS campaign may already be apparent. For example, there are a reported over seven hundred non-governmental organizations in Uganda alone involved in the campaign to fight HIV-AIDS. According to Makumbi, the country’s Minister of Health, a few of the organizations do a good job. But his government has not way of knowing, monitoring, and evaluating what the rest of the organizations are doing. “Unfortunately, a good number of them do rush in, collect data and go away with it, and the next we hear about it is when it is being printed in journals. And we have not had any input. Some of the work has been done in very limited areas, not reflecting the rest of the country.”(Ankomah, 1998:42) The possible outcome of this ill-gotten data may be further circulation of skewed erroneous data that further distorts the prevalence of HIV-AIDS not only in Uganda but “Africa” as the Western media prefers to characterize these reports. There is also evidence in rural areas where these AIDS agencies have been operating that people (both villagers and indigenous Aids workers) are beginning to exaggerate the reports of the incidence of AIDS with the full knowledge that higher numbers of reported Aids with generate more goodies, assistance, money or funding from foreign donor agencies.(Shenton, 1998:165)
There is additional evidence that donor agencies may ignore addressing the obvious traditional less glamorous causes of ill health like lack of clean water, poverty, malnutrition, and bad hygiene such as lack of pit latrines in poor rural African countries. Instead they may focus on distribution of condoms and conducting sex counseling, and perhaps the giving out of clean needles. (Shenton, 1998: 167) The point is not that promoting safe sex through use of condoms is bad in itself, but rather that having clean water, fighting poverty and malnutrition perhaps has a wider impact and therefore should have a higher priority. May be both should be conducted simultaneously.
Strategy for Explaining HIV-AIDS
Tropical Africa has been known to be the possible origin of many epidemics. But this doesn’t mean that every epidemic that is mysterious has to be somehow attributed to Africa or everyone of African origin. The HIV-AIDS origin and the apparent prejudices which continue to be associated with it is a classic.
An objective discussion of disease in tropical Africa cannot skirt the issue that there is historically a legitimate reason to believe that most epidemics may have originated in tropical parts of the world in the process of human evolution(Lappe, 1994:13; McNeill, 1977; Karlen, 1995). However, today this evolutionary reality is mitigated by the fact that other dramatic changes in the environment, medicine, travel and global social networks no longer make tropical Africa the obvious and prime source of disease. There are now drug resistant bacteria, pollutants, carcinogens, and ecological insults to ground water.
“Epidemics are again a regular part of the news. The genital herpes virus infects half the people in the United States. Chlamydia, virtually unknown until twenty years ago, has become the country’s most common infectious disease after the common cold. Germs that used to attack cats, rats, sheep, and monkeys have sickened people from Albuquerque to Moscow. Many forms of cancer are more common, and viruses are implicated in helping to cause several types. Viruses are also suspected of playing roles in chronic fatigue syndrome, Alzheimer’s disease, rheumatoid arthritis, systemic lupus, and multiple sclerosis. In recent years, syphilis, tuberculosis, measles, whooping cough, and diphtheria have surfaced not only in poor but in developed nations.”(Karlen, 1995:5)
This quote suggests that when science, spearheaded by he Western media, continues to promote the one-germ-model, in the light of all the other contradictory factors and evidence, this may be not only wrong, but makes it difficult to find the real cause(s) of the HIV-AIDS epidemic. This may also result into the promotion of injurious public health policies and campaigns especially in Third World countries like those in Africa.
One of the biggest errors in the HIV-AIDS epidemic is the original claim (since then still unsubstantiated claim) that HIV came from Africa transmitted through green monkeys that are believed to have bitten a human in the jungles of Africa.(Sabatier, 1988) This was compounded by a sensational story that spread like the proverbial wild fire in the early 1990s; that the AIDS epidemic had core-infected areas in Kenya, Uganda, Tanzania, Zambia and Zimbabwe. Phillipe and Evelyne Krynen are a couple sponsored by the French charity, Partage, who originally broke the sensational AIDS story to the world. At that time in the early 1990s, the news about whole villages being wiped out and leaving orphans garnered so much sympathy and alarm in the West. Huge resources including manpower were diverted to fight AIDS in this part of Africa. Since that time, major international organizations like WHO, UNICEF, European Commission’s Global Fight Against Aids, and thousands of agencies have been involved.(Ankomah, 1993:8)
But after they had worked in Northern Tanzania for four years in what was considered the AIDS epicenter, the Kryenens discovered that they may have been wrong. Asked about AIDS in the region, their reply was: “There is no aids. It is something that has been invented. There is no epidemiological grounds for it; it doesn’t exist for us.”(Ankomah, 1993:8) The Kryenens had investigated Aids for four years and now were confessing that they had made a mistake in their original story. When this story broke in the Sunday Times Newspaper in UK, it was like a bomb going off. Doctors, organizations, and other Aids agencies vilified the Kryenens and the investigative reporter. “What nonsense! Was the general verdict. Everyone knows that Africa is crawling with Aids! Tests prove that millions of Africans are HIV-positive and HIV leads inevitably to full-blown Aids. Who are the Kryens to tell the experts that there is no Aids epidemic in Africa?”(Ankomah, 1993:8)
This reaction typically reflects what has been happening in the investigation of the HIV-AIDS epidemic. The Kryenens, reporters, and perhaps other indigenous people and experts may have a better grasp about what might be really happening in the field in Africa. But the experts in London, Paris, and New York, who create the news and drive the health policies, may be the ones who know the least about what is really happening on the grass roots in Africa.
The Kryenes’ explanation about their error might reflect what may be happening now in the HIV-AIDS diagnosis in Africa. Based on the information they had been given prior to coming to Tanzania, at first they assumed that most deaths were due to Aids. But after some research, they were faced with some cases that did not make medical sense. They discovered that when HIV positive patients were treated for their diseases like TB or pneumonia, they recovered just as quickly as those patients that were HIV-negative. “They carried out mass testing and were surprised to find that a far smaller percentage of the population had positive results than earlier research had indicated. They began to suspect that there was either something wrong with the test procedure or that (HIV) positive results were being triggered off by other bacteriological infections.”(Ankomah, 1993:10)
After living in the area for a long time, the Kryenens began to realize that the “orphans” were not really orphans. Their parents had left to work elsewhere and sometimes sent some money back to the village. But the extended families, including grandparents, were raising the children. This was an apparent cross-cultural misinterpretation of the significance of the extended family in child rearing in African societies. But all these children were and continue to be frequently mistakenly reported in a sensational way in the Western press as “Aids orphans”. Most Western researchers rarely recognize or acknowledge that the structure and endurance of the African family may be remarkably different from the nuclear Western monogamous family. In fact African scholars like Mazrui (1986) have asserted that the African family might be the only enduring, resilient, indigenous, and authentic African social institution.
Implications for Medical Science
In this part of the paper, the author will argue that the most productive, logical, and scientifically legitimate is the co-factor or the multifactorial approach to HIV-AIDS.
What may be the premature driving to a consensus to the “HIV-AIDS-equals-to-death-hypothesis” by the dominant medical community may cost science its integrity and genuine progress. A great deal of money (Shenton, 1998:31) seems now to be driving both the HIV-AIDS debate (if there is any at all) and health policies. This has resulted into the strong possibility that many scientists have compromised the integrity of their work in abandoning honest debate and pursuing lines of scientific investigation that are least likely to displease or contradict the HIV-AIDS orthodoxy.
A case in point is that of a Dr. Marie Deschamps who was a bright doctor who was to shortly publish a paper in the Lancet. She described an eight-year study in Haiti of 920 sexually active couples; 475 of these couple had one of them HIV negative and the other positive. The couples were not using condoms. After those eight years, only thirty-six couples both became positive and the other 439 couples did not infect each other. In normal scientific investigation, this finding was begging for numerous alternative explanations including challenging some aspects of the HIV-AIDS hypothesis. When asked about the surprising findings, Dr. Deschamps exhibited unwillingness to explore the possibility of a wide variety of explanations. She seemed unwilling to challenge the accepted orthodox view.
“The closed mind, rooted in the accepted wisdom on HIV and AIDS, had to look for explanations within her own hypothesis. Where was the scientist’s curiosity, we again wondered, that might have yielded explanations other than the accepted wisdom? Where was the inclination at least to listen to those who doubted the infectivity of HIV? What had happened to doubt and questioning among scientists?”(Shenton, 1998:199)
In the HIV-AIDS discourse to day, disagreement based on logical reasoning, analysis and exposing inconsistencies in the research is simply either smothered or excluded from the mainstream debate in journals, AIDS conferences, and electronic media. The classic case of an opposing view in the HIV-AIDS research being smothered and excluded from the mainstream or HIV-AIDS orthodoxy is that of a distinguished molecular biologists Peter Duesburg. (Shenton, 1998; Hodgkinson, 1996). He and several other scientists constitute a small and less powerful but consistent number of critiques of the HIV-AIDS-equals-to-death hypothesis.
The scientific medical community is perhaps experiencing the normal frustrations of a revolutionary shift in the medical diagnostic and epidemiological paradigm. What is happening in the HIV-AIDS controversy may have parallels to the shift that happened in medicine when the pellagra epidemic was common in communities in Europe. Pellagra is a niacin (vitamin B) deficiency induced disease that was common in poor communities in Europe whose staple food consisted of processed maize or corn flour. “Although pellagra did not spread beyond its risk groups, a classic indicator of a non-infectious disease, and never affected nursing staff, many doctors pronounced it a contagious bacterial disease. Patients with the disease developed terrible skin lesions, nerve damage, dementia, diarrhea, wasting syndrome and finally died.”(Shenton, 1998: xxix)
Pellagra infections were confined to the risk groups of the poor and sailors. For 15 years from the 1920s, Dr. Joseph Goldberger alone battled the mainstream medical establishment at the time that believed pellagra was caused by a bacterium. Goldberger went as far as infecting himself with patients’ blood to prove to his adversaries that pellagra was a non-infectious disease. Many people continued to die until niacin was isolated in the 1930s. Are we witnessing a similar scenario with HIV-AIDS ? The infections have been confined to risk groups for the last eighteen years. Alternative hypotheses are neither seriously endorsed nor investigated while the one-germ- or virus theory in the accepted one. Instead of focussing, almost to a point of obsession, on Africans, chimpanzees and monkeys in jungles in Africa as being the source of HIV,(Ankomah, 1999) scientists should be seriously exploring other alternative explanations. Besides numerous other factors, some African countries in Southern Africa, for example, have maize as their staple food. As a follow up to the example just discussed, could African urban dwellers be partial victims of pellagra and poverty especially if the maize is processed without vitamin fortifications and nutritious food supplements more easily available to their rural counterparts?
Given all the ambiguity, cross-cultural complexities, and the unknowns, the HIV-AIDS research should expand and focus beyond the narrow confines of the HIV-AIDS-equals-to-death hypothesis. The scientists should focus on the following:
- Seriously investigate all major alternative hypotheses in the relationship between HIV-AIDS
- Seriously investigate the possible multifactorial or co-factors in the relationship between HIV and AIDS: malnutrition, environmental pollution, the impact of chemical food contamination, chronic drug abuse including alcoholism, the role of extreme physical and emotional stress in contemporary life styles.
- Explore the role of extreme sexual promiscuity or liberalism and all exotic sexual practices (anal and oral sex, prostitution, drug use especially chronic alcohol abuse, numbers of sex partners, frequency of travel and location of sex partners) in sexually transmitted diseases (STDs) among some heterosexuals, homosexuals, and international travelers and tourists. This should not just mean scrutinizing the health status of all immigrants and travelers from poor Third World countries to developed countries. But also equally exploring seriously that travelers and the elite from rich and poor countries may transmit lethal pathogens to vulnerable Third World populations who may not have the resistance to drug resistance microbes. Racial and cultural superiority complex leads Western society to believe that because of advanced medical technology, the Western has less STDs than developing countries. “The claim of such supporters in the developed world does not appear 100 percent correct, because the incidence of venereal disease is much higher in spite of their positive claims. Even after the cure the incidence of reinfection is much advanced. Although the people are conscious about sexually transmitted diseases, they are reluctant to adopt precautionary measures, even in the developed countries.”(Garg, 1987:63)
- Seriously consider the possibility that there may be a third obvious simple factor or factors that cause(s) AIDS that is being ignored because research in HIV, testing, and cure lends itself more easily to the use of sophisticated, fancy, financially lucrative and seductive modern bio-chemical equipment in the expanding field of microbiology and bio-technology. This author could not resist use of the analogy of the man who lost his keys on a dark part of the street. He was observed erroneously looking for the keys under a well-lit street lamp fifty yards away. Asked why he was looking for his keys clearly in a wrong place, his reply was that this is where the light was.
- All scientists should take the difficulties, obstacles, and sometimes barriers involved in cross-cultural research very seriously if the pursuit of reliable and valid scientific knowledge is the objective of many of the HIV-AIDS studies. Africa, for example, is a giant or huge continent which has a total area of 11.7 million Sq. Miles (30.3 M. Sq. Kms). Table 1 shows the size of four countries and Europe compared to Africa. It is more than 3 times the size of the United States.
|Country||Area (Sq. Mi)|
|TOTAL||11,664,680 Sq. Mi.|
|Or||30,211,551 Sq. Km.|
|TOTAL||11,664,680 Sq. Mi.|
|Or||30,211,551 Sq. Km.|
|Africa’s area:||11,707,000 sq. mi|
|Or||30,321,130 Sq. Kms.|
|Source: AFIM||(Africa Interactive Maps, 1998)|
Table 3: Size of Africa compared to four countries and Europe
- In addition, the continent has 54 mostly sparsely populated countries with tremendous geographic, physical, climatic, linguistic, ethnic, religious, historical, economic and cultural diversity and complexity.(AFIM, 1998) Some of the highly sensational HIV-AIDS research findings, most of it qualifies as conjecture and speculation, are discussed in terms of such broad generalizations as…”African peadriatic AIDS” ….”HIV originated in the African jungle” …….”the HIV-AIDS epicenters of Africa”. These gross generalizations and distortions prevent any clarity in the investigation of the problem.
What Should Zambians/Africans do?
The ambivalent use of “Zambia” and “Africa” is deliberate in the paper. But more importantly it reflects the kind of ambivalence that all serious scholars of HIV-AIDS in Africa should exhibit. A discussion of HIV-AIDS in “Africa” may ignore the fact that many countries in Africa are reported not to have high incidence of HIV-AIDS. Some of the countries, like Zambia, Uganda, and Tanzania have been targeted and identified as HIV-AIDS epicenters. How does one meaningfully discuss the subject as relating to “Africa” when there may be such marked differences between the African countries? The countries differ in terms of levels of urbanization, prevalence of migration and civil war and unrest, political stability, cleavage and conflict, medical infrastructure, volume of tourism, levels of formal education in the population, ease of transportation and travel, and the existence of international and national communication, exposure to Western television, languages, provision of food and development of agriculture.
This is why this author argues that with regards to the HIV-AIDS disease investigation, it would make more sense to first explore the etiology and pattern of the disease (if it exists at all) in the West, and then in each African country and then later for investigators to compare notes. The current strategy of employing, adopting, and imposing the monolithic single-germ theory developed by Western medicine on the entire African continent, while for the most part disregarding all other factors, will only yield sensational, meaningless and predictably confounding results. The frequent statement of befuddlement you hear through the Western media is: “HIV-AIDS is mainly a homosexual or gay disease in the US but it is a heterosexual disease in Africa”. The current research strategy will never yield valid answers to this question and many others so long as the focus is on just “Africa”. This author proposes that all serious Zambians and Africanists should do the following in the HIV-AIDS research:
- Investigate and determine whether HIV-AIDS does exist in relation to the history and etiology of diseases that are indigenous to their individual countries. Many of these diseases that today may be clinically classified as new and HIV-AIDS related, may have existed before. Exploring the African traditional diseases through examining folklore may be one strategy.
- Compare death rates in the individual countries prior to the 1980s and after the 1980s to see whether HIV-AIDS may have claimed as many lives or contributed to an epidemic rise in the death rates. Has there infact been a population growth? Did deaths and displacement due to civil war severely reduce the population?
- Seriously investigate the multifactorial or co-factor explanation of HIV-AIDS. Special attention should be paid to the role of indigenous diseases including malaria fever, tuberculosis, elephantiasis, sleeping sickness, leprosy, river blindness, schistosomiasis, yellow fever, cholera, marasmus and kwashiorkor malnutrition diseases, other parasites, viruses and bacteria. A combination of these might in themselves explain cases of the incidence of AIDS disease without HIV (Root-Bernstein, 1993) especially in testing the synergistic model of disease or the immune system stress overload theory of HIV positivity and negativity.
- Seriously investigate levels of hygiene especially in overcrowded poverty stricken shanty compounds of major cities as this may be the key co-factor in the AIDS symptoms even without HIV.
- Determine the levels and impact of drug abuse (cocaine, heroine, marijuana, heroine, mandrax, sexual stimulants and others) including alcohol.
- The area of sexuality may have experienced the most dramatic change in individual African countries. There should be a serious and honest investigation of the nature, volume or magnitude of sexual activity in each country. A calamitous break down of the more restrictive African traditional sexual morals combined with exposure to Westernization and the sexual revolution that occurred in the West in the 1960s and 70s may have increased the prevalence of Sexually Transmitted Diseases to a level before unknown in the country. An increased access to pornographic videos, internet, magazines, alcohol, and drugs may further fuel excessive sexual activity. “In higher species, copulation offers germs many ways to spread, by the contact of skin, mucous membranes, body fluids, and breath. ….. Humans are an especially fertile field for such germs, because our eroticism is unmatched in nature. ….No other mammals couple in as many nonproductive times and ways – orally, anally, homosexually, during pregnancy and lactation, sometimes before fertility starts and after it ends….One consequence has been an explosion in the incidence and variety of STDs.”(Karlen, 1995:122) Mcilhaney (1990) and Garg (1987) have identified more than twenty sexually transmitted diseases that exist to day that include gonorrhea, syphilis, Human Papilloma Virus (HPV) infections or Venereal Warts, AIDS, hepatitis B, vaginitis, chlamydia, herpes, public lice, molloscum contagiosum, mycoplasma infections, amebiasis, giardiasis, and gay-bowel syndrome. If many of these STDs exist in large numbers of the population combined with malnutrition and many other indigenous diseases and emotional and physical stress due to, for example to massive urban poverty and economic hardship, would not all these factors not cause the immune system to be overloaded and therefore to result into symptoms such as AIDS? The HIV-AIDS orthodoxy have largely ignored the cases where people show AIDS symptoms while they remain HIV negative.(Root-Bernstein, 1993; Shenton, 1998; Adams, 1989) What if elite of African countries brought the STDs from the Western countries where these may have been already drug resistant, would this, combined with other factors, not cause massive immune breakdowns in the African victims exhibiting itself in the AIDS symptoms and death?
- African countries should embark on a serious scientific exploration, investigation, and documentation of the indigenous or traditional etiology of disease. Traditional diagnostic and healing methods may become very valuable in the near future. The West and Westernized Africans have erroneously been confusing the so called “witchcraft”, “witchdoctor”, “vodoo” with the African traditional legitimate healing methods and the African traditional healer.(Tembo, 1993) They have successfully induced a certain shame and inferiority complex among Africans about African indigenous methods of healing and use of herbs. Some of these same methods that are known as being primitive and showing backwardness are now being incorporated into medicine to day in the West as “alternative medicine” or “healing”(Tembo, 1993; Clark, 1993; Christy,1994) This negative attitude of inferiority complex among Zambians/Africans will be very difficult to reverse.
- Lastly, Africa and Africans are vulnerable and badly need to defend themselves. Anybody to day can make the most unfounded, scurrilous or preposterous very negative assertions about Africa and Africans, there is often no one to defend the continent and the people. As a result, most people to day believe that HIV-AIDS came from a monkey that bit an African in the African jungle when there has never been any evidence to support this assertion or speculation. This hypothesis was expressed during the early days of the HIV-AIDS epidemic in the mid 1980s. Many of these and similar assertions are made in the name of “science” and “scientific” investigation and findings. When such clearly reckless assertions are made, most with racist undertones, Africans and African experts everywhere should be willing to step forward where possible and rationally challenge such harmful remarks.
Since the HIV-AIDS was discovered in the 1980s, the information about the deadly disease has been spread far and wide in the whole world. Appropriate private and public health care institutions and organizations have been mobilized to fight the “epidemic” costing resources in billions of US dollars. The controversy about the possible serious flaws in the diagnosis of the disease has been largely kept out of the mainstream scientific debate and the public. It is hoped that this paper has not given the impression that readers should deny the possible existence of HIV-AIDS or killer disease. But rather that people might be dying of a new disease or a group of old diseases and that all the possible explanations and hypothesis should be open to investigation in line with logic and genuine scientific procedure.
This paper recognizes that the HIV-AIDS disease has generated large volumes of information in its colloraries including origin or history, diagnosis, prognosis, cure, prevention, and public healthy policy. In the context of its limited objectives, the paper has focussed on a number of key flaws in the hypothesis. It is hoped that readers will realize that if the basic foundation and premises of the HIV-AIDS hypothesis are themselves extremely weak and questionable, what is the logic of vigorously searching for the cure and generating to what amounts to massive fear, anxiety, and hysteria and possible deaths in what might turn out to be a possible misguided public campaign to eliminate the disease? It is hoped that even if the paper does not change anyone’s mind, that atleast it will encourage the readers to open their eyes and begin to ask questions of their doctors, medical establishments, pharmaceutical companies, the media, government, researchers, co-workers, neighbors, relatives and friends. This quote from Hodgkinson probably best summarizes the status of the HIV-AIDS disease to day.
“It was and is wrong to tell people they are carrying a deadly new virus on the basis of an unvalidated test, beset with technical problems and pitfalls in interpretation, vulnerable to shipping, climatic and storage conditions, and subject to unmeasured and probably immeasurable cross-reactivities and hence false positive results. It is very hard for doctors, scientists, politicians, the World Health Organization, gay leaders, Aids charities and even journalists to admit to this today, since they have all been instrumental in bringing about the climate of opinion in which this unvalidated test was inflicted on millions. But those are the facts. Regardless of whether or not the test has any relevance to a retrovirus, there are so many other possible causes of a positive result that on present knowledge, no one should be diagnosed as suffering from ‘HIV’ infection or disease. No one cognizant of these facts will ever wish to allow themselves to be tested. The sooner the error is acknowledged and the test relegated to history, the quicker we may see a return to sanity in Aids science.”(Hodgkinson, 1996:262)
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This article summarizes the multiculturalism debate that raged on college campuses in the late 1980s and early 90s. The HIV-AIDS is not discussed. But the political correctness may have been relevant in understanding the path the HIV-AIDS debate took. In the article, political correctness is defined as: “a pejorative term for a pattern of behavior in which discourse, argument, and good sense are stifled by an imposed conformity that places maximum value on giving no offense to such ‘marginalized’ groups as women, people of color, gays and lesbians, Jews, Muslims, and the poor.”(Mackenzie,B1-B2). Tembo, M.S., “Being Oversensitive about nothing: the Potential Impact of “political correctness” and Multiculturalism on Knowledge.” Proteus: a Journal of Ideas, Vol. 10, No. 1, Spring 1993.
The use of Zambia instead of Africa has been done deliberately and for a purpose. The use of “Africa” in discussing cases of HIV-AIDS in Uganda and Zambia, for example, only reinforces the stereotype which in unfortunately very prevalent in the West; that Africa is just one small country. This very persistent stereotype leads to the often ridiculous conclusions that if there are high “estimated” cases of HIV positive individuals in Kampala in Uganda or Lusaka in Zambia, then the whole of Africa has high HIV positive rates. Africa today is very heterogeneous and complex.