Editor—As a prison medical officer in South Africa, I partly agree with President Mbeki's sceptical view of current statistical research into HIV infection and AIDS.1
The research data tend to be formulated from actuarial models and short trials in pregnant women attending antenatal clinics. Pregnancy is known to cause a raised rate of false positive results on testing for HIV infection with enzyme linked immunosorbent assay (ELISA). The results of such research lead to frightening statistics, giving the impression that the whole of southern Africa will be depopulated within the next 24 months.
In South Africa's prisons there is a vast overcrowded (often 30 people per cell) population in which homosexuality is widespread and condom use practically non-existent. This is the perfect breeding ground for the rapid spread of HIV.
Sexually transmitted diseases are common in the prison where I work, and all prisoners who have any such disease are tested for HIV. Prisoners with any other illnesses that do not resolve rapidly (within one to two weeks) are also tested for HIV. As a result, a large number of HIV tests are done every week. This prison, which holds 550 inmates and is always full or overfull, has an HIV infection rate of 2-4% and has had only two deaths from AIDS in the seven years I have been working there.
The HIV infection rate for all South Africa's prisons is currently 2.3%. The rate in the prison population should be higher than that in the general population, or at least the same. But the figures for prisons in South Africa are way below those generated by actuarial models and antenatal data, which purportedly reflect the incidence of infection in the general population.
A widespread mystical attitude towards HIV/AIDS gives this disease recognition out of all proportion to its incidence (compare it, for example, with the number of deaths in southern Africa from malaria, tuberculosis, malnutrition, road crashes, and murders). The legal and ethical implications of this attitude ensure that no statistical research is based on random testing of the general normal healthy population. Data from this kind of research, were anyone brave enough to conduct it, would probably show figures more like those found in the prisons.
References
- 1.Sidley P. Mbeki plays down AIDS and orders a rethink on spending. BMJ. 2001;323:650. . (22 September.) [PMC free article] [PubMed] [Google Scholar]