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The great cover-up of AIDS

Why are so few people being honest about the extent of the problem and the risks? AIDS is a hard illness to talk about, especially in Africa and Asia.  In Africa there is an added sensitivity: confronted with a tragedy affecting their whole continent---and for once not related to war or famine---in an international atmosphere which they see as racist, many have been extremely unwilling to be honest. They are afraid of anti-black backlash if it is said that the problem started there. They are also afraid of economic ruin due to decisions of multinational companies to pull out, and the collapse of their tourist industries. Many of these countries desperately need foreign currency to prevent total bankruptcy. In addition it has often been difficult for doctors to be sure of the diagnosis. Testing is expensive, kits are hard to obtain, and sometimes hard to use. Indirect methods have to be used such as a negative skin reaction to the standard tuberculosis (TB) test. Most AIDS-related deaths seem to be happening out in the bush, unnoticed and unregistered. The wards and clinics see mainly early cases.

So we have a bizarre situation where doctors in these countries may be reeling under an impossible workload, and where even government members or relations of the country's leaders may be dying, but the problem is denied, or blamed on other causes, or impossible to assess.  Scientists studying the epidemic in Central and Southern Africa are often there under tolerance. Intensive research is going on all over Africa to understand the disease, but the results are sometimes censored. A scientist may have to sign an agreement not to disclose publicly what he sees happening.

Information is leaking out all the time, but if it is traced back to a particular person or team the workers may be thrown out of the country or into prison. Fortunately, the situation is changing. It has to. The cover-up has had one appalling consequence which prevents an educational campaign. How can a country embark on mass prevention for a disease it says it does not really have? Once again we see denial for emotional reasons too, not just economic ones. How can you accept from a mathematician that maybe a third of your entire nation could die?

South Africa has had its own reasons to cover up. It has an enormous problem, especially in the black townships where huge numbers of migrant workers come from countries further north in which AIDS is taking a terrible toll.

In places like Soweto, the town providing labour for the deep mines in Johannesburg, there have been up to 50,000 men living without their wives (officially). In the days of apartheid their wives and children were all meant to stay in homelands like the Transkei. They didn't, of course, and drifted out in search of their husbands to build illegal residences made from corrugated iron, wood and plastic. Every now and then these `shanty towns' were bulldozed to the ground and the women trucked back, sometimes more than 1,000 miles away.

Fifty thousand men on their own with a few prostitutes spelt trouble---yet this situation has been common in South Africa. The historic white government had no political will to change anything. For them, a major disease that selectively hit black Africans and offset the birthrate may have been convenient. But the new post-apartheid regime has also found it hard to talk about AIDS.  Nelson Mandela fought for recognition of the disease, but when he handed over leadership of the nation the government mood changed to one of confusion and denial.