Aids there is hope but. (Feature).

Mukai Chimutengwende-Gordon is a fifth-year medical student at Bristol University, England. Last summer, she carried out a Special Study Research Module (SSM) on "Aids in sub-Saharan Africa", using Zimbabwe as her base. This is what she discovered.

I cannot understand how any doctor can confidently say that HIV testing in Africa is acceptably reliable. In the developed world HIV testing consists of the Enzyme-Linked Immuno-Sorbent Assay (ELISA) test followed by the Western Blot test. This is because studies have shown that the ELISA rest alone produces at least an 83% false positive test result rate. However, in Africa, due to lack of resources, testing usually consists of the ELISA test only. Often, HIV resting is not even performed and people are diagnosed on the basis of unspecific symptoms such as weight loss and diarrhoea.

Unfortunately, the widespread introduction of the Western Blot test is unlikely to improve the situation as many other conditions have been shown to produce the same antibody response with this test that HIV is said to produce.

The p24 protein that is detected by the HIV antigen tests has also been found in other viruses. Even measures of HIV progression, such as CD4 counts and viral load are affected by other factors. For this reason, viral load measurement is not supposed to be carried out within a month of infection.

Antiretroviral drugs are another huge concern. Long term use is known to cause immunosuppression and side effects that are actually indistinguishable from Aids. The pharmaceutical companies do not even attempt to deny this.

Millions of people have been encouraged to put all their hope and trust in these drugs. I doubt that they are told that in 10 years time when they develop symptoms of "Aids", no one will really know whether it is due to the HIV or due to the identical fatal side-effects of the drugs.

One case I encountered in Zimbabwe, which illustrates some of the dissident concerns, is that of a woman called Lynde Francis. She set up The Centre in 1992, a place to provide counselling, support and nutritional guidance for HIV positive people.

Lynde herself has been living with HIV for 17 years now and has had no symptoms of Aids or opportunistic infections at all. She has never used antiretroviral drugs and says that she maintains her health by maintaining a strictly healthy diet and lifestyle.

Also, of the clients who have attended The Centre, the only ones who have died are those who came in the very late stages of "Aids" or those who had taken antiretroviral drugs.

According to the mainstream view of Aids, 17 years is a long time to live with HIV without treatment. Was Lynde Francis misdiagnosed? Would she have remained symptom-less for so long if she had taken antiretroviral drugs? The toxicity of antiretroviral drugs would make this unlikely. It is a possibility that she would have developed symptoms or even died of immunosuppression due to the drugs by now if she had used them. It is almost certain that this would have been presumed to be "Aids".

The Mother of Peace Community at Mutoko is another case that raises some questions. The Community provides a home for 141 orphans and has been operating for eight years. Most of the children are not tested for HIV, but many of them are sent to the Community with symptoms of "Aids." The children all come from very poor backgrounds and starvation is prevalent in Mutoko.

However, many of the children appear to make a full recovery after spending a few months at the Community. The matron, Jean Cornneck, attributes this to the emphasis on "a balanced diet and tender, loving care" at the Mother of Peace Community.

This raises several issues. Were the children misdiagnosed as having HIV on the basis of unspecific symptoms? It is unlikely that they would still be alive if they had not gone to live at the Community. They would probably have died of poverty-related conditions or starvation. Since, the assumption was made that their parents had died of Aids, it is likely that their deaths would have also been attributed to Aids, (when it is clear that their deaths at that point would have been preventable). Most children or adults in Africa, thought to have symptoms of Aids, do not have the opportunity to go somewhere like the Mother of Peace Community. Hence, it is disturbing to wonder how many preventable deaths in Africa are wrongly being attributed to Aids caused by HIV. How many lives are being written off unnecessarily?

Whether or not these individuals have HIV or something else had caused a lowered immune status, the lifestyle adopted (in the children's case--elimination of starvation; and in Lynde Francis's case--adoption of a healthier lifestyle) appears to have increased the quality of life and the healthy lifespan.

It seems a shame that there is not a greater emphasis on these simple measures as they may have the potential to considerably reduce personal suffering for many people.

The research I carried out taught me several important lessons. Firstly, doctors and medical students should be wary of stereotyping their patients. It is still not unusual to encounter stereotyping as a part of medical teaching. For example, in my experience, whenever the case of an Indian person with a cough is put forward in tutorials, medical students always think of tuberculosis first. This is not the case for patients of other ethnic origins.

Similarly, a photograph of a thin, emaciated person from sub-Saharan Africa shown to students rings the alarm bells of Aids, which in view of conventional theory is understandable. However, it worries me that alternative diagnoses tend not to be considered as they would for a non-African person. This practice is dangerous, and it is one that I will not partake in. Another lesson is that it is vital to be open-minded and remember to look beyond what one is taught at medical school. Before writing my Special Study Research Module (SSM), I attempted to discuss the HIV debate with many doctors. With the exception of a few, I was told the dissident view was simply "a load of rubbish."

One Harley Street doctor even advised me not to include an analysis of the theory in my SSM as my medical school would probably fail me. I did not take this advice and I am pleased to say that, that has not been my experience to date. In fact my supervisor found it very useful. She recommended it for publication and organised for it to be placed in a library so that other students and staff can use it.

I also did a presentation of the subject to my classmates and a professor. I was dreading it, as I remembered the many vicious insults and the ridicule of the dissidents that I had read and heard.

However, it seemed that it was necessary to rake the risk as a few people in my year are planning to work in Africa. Someone has to try to give them "food for thought", as most of what we hear about the dissident view is grossly distorted.

My worries were unfounded though. The professor and my classmates were fascinated. They had never heard both sides of the debate reported in detail and they wanted to know more. So, there is hope. Perhaps the vicious attack and extreme resistance on the part of doctors is due to lack of knowledge and simply raking things at face value in some cases. If more doctors are given detailed and balanced information, more will be able to make up their own minds regarding the subject and will try to work out what is really going on with regards to Aids. At present, fair information on both sides of the HIV debate is nor always easy to find. I have seen dissidents misrepresented as simply crazy scientists who for no apparent reason have decided nor to believe that Aids exists or that HIV causes Aids. There is often no further explanation.

This of course makes no sense to people who do nor already know the arguments. Hence, people do nor understand the real arguments and as a result even those without a vested interest develop strong anti-dissident views without any knowledge of what it is really about. Sometimes elaborate stories are developed regarding the dissidents being "in denial" or prejudiced against those with HIV or Aids. Whether or nor the dissident view is entirely correct, it raises issues that would be irresponsible to ignore. If an unreliable rest (and sometimes no testing) is being used to diagnose HIV in Africa, how can we be confident that giving toxic anti-retroviral drugs to people under these circumstances is acceptable?