Essex’s erroneous research spawned the theory that HIV originated in African monkeys. This misconception is critical because the concept is a pillar for the fallacy that HIV/AIDS is endemic in Africa.

In 1985, it was Essex and his team of investigators that “discovered” an “AIDS-like” virus in the blood sample of wild-caught African green monkeys (AGM). This “AIDS-like” virus eventually came to be called SIV, the Simian Immunodeficiency Virus; even though it did not cause immunodeficiency in African green monkeys.

AIDS was a hot topic at that time; the discovery of SIV by the Essex team was instant front-page news worldwide. Both scientists and the public were striving to make sense of this terrifying mystery, and the impact of this initial media acclaim continues to reverberate throughout the medical and mainstream media today, as well as adversely affecting HIV/AIDS and general health care interventions in Africa.

Yet, in 1988 – only 3 years later – the truth came out! SIV was not from Africa! SIV was not a new virus! Rather, what was thought to be SIV was actually another virus, which had contaminated the blood samples of the African Green monkeys.

This contaminating virus originally came from Rhesus macaque monkeys. As a species, Rhesus macaques originated in Asia, but these particular Rhesus macaques were residents of the United States, and lived at the New England Regional Primate Research Center (NEPRC) in Southborough, Massachusetts, where various species of primates were housed and bred for the purpose of medical experimentation.

Several months prior to the discovery of “SIV,” a researcher at NEPRC, Phyllis Kanki, had isolated the virus from 4 sick Rhesus macaques monkeys. She then gave Max Essex a sample. Three years later, another group of investigators compared the genetic structures of SIV (“discovered” by Essex) and the virus from Rhesus macaques. Genetically, the two viruses were 99% identical; meaning they were the same virus. The viruses Kanki had given Essex had contaminated the blood samples of the wild-caught AGMs in the team Essex laboratory (the blood samples but not the monkeys were brought over from Africa).

In 1988, Nature, the leading interdisciplinary scientific journal, published a letter by Essex admitting this contamination and its source. Nature also published the genetic analysis that exposed the contamination. However, both the admission and the genetic analysis seemed to pass unnoticed by the medical and scientific community at large – even though Nature followed up several months later with a short editorial entitled “Human AIDS Virus Not From Monkeys”.

Nonetheless, 6 months after Essex’s letter of admission was published in Nature, Scientific American – a magazine of far greater distribution – published an article co-written by Essex and Kanki entitled “The Origins Of The AIDS Virus” which featured a full-page, color photo of the African green monkey.

Thus, the theory that HIV originated in Africa primates perpetuated. This theory changed over time as the species identified as the source of HIV’s progenitor shifted from AGMs to sooty mangabeys to the common chimpanzee, the chimpanzee currently bearing the crown stamped “Origin of AIDS.” To date, dozens of SIVs have been isolated from at least 30 species of African primates, none of them causing immunodeficiency; nevertheless, they all are labeled “closely related” to HIV by the investigators who discovered them.

This categorical use of the misnomer “immunodeficiency” in this crop of viruses reflects the “plight” of virologists. To get funding, it’s best to be working on a primate immunodeficiency virus. The situation is analogous to the height of the ‘War on Cancer’ in the 1970s. At that time, any virologists working on viruses labeled oncogenic (causing or inducing tumor formation) were viewed in particularly favorable light by funding agencies.

In relation to the current situation with HIV/AIDS, this prerogative continues to afflict HIV/AIDS research funding and interventions across many scientific, medical, and allied professional domains.

Given all the known retroviruses “closely related” to HIV derived from primates in Africa, it is ironic that only 2 primate retroviruses are known to induce an analogous immunodeficiency in their original hosts; and both these retroviruses and their hosts come from the United States. The first is SIVmac, the aforementioned virus isolated from Rhesus macaques by Phyllis Kanki. The second is HIV. HIV infects the primates called humans.

Phyllis Kanki originally isolated SIVmac from 4 Rhesus macaque monkeys which had an immunodeficiency syndrome with a “remarkable similarity” to human AIDS. As with human AIDS, the immunodeficiency experienced by these Rhesus macaques was characterized by opportunistic infections; namely, candidiasis, cytomegalovirus infection, and cryptosporidiosis — all diseases characteristic of human AIDS as well. The appearance of these diseases in humans and Rhesus macaques means that their respective viral infections both damage the defenses of cellular immunity. Cellular immunity defends the body against fungi, virus, and parasites, specific types of infections that flourish during HIV infection. The bacterial defense mechanism, humoral immunity, remains intact during early HIV infection.

Kanki’s discovery of SIVmac and “simian AIDS” raised no great acclaim. She soberly suggested that SIVmac and Rhesus macaque monkeys might be suitable models for experimentation and drug development; an appropriate suggestion, but it was not until after the same virus was “discovered” in African green monkeys that it received any fanfare.

An exuberant reader might theorize, given the geographic juxtaposition of SIVmac and HIV, that SIVmac and Rhesus macaques represent the origin of HIV and AIDS. However, SIVmac shares only about 50% genetic homology (‘relationship’) with HIV, and collectively, all the African primate retroviruses share about 50% genetic homology with HIV.

SIVmac shares about 75% genetic homology with all the African primate retroviruses. So, genetically, SIVmac is more closely related to the set of harmless Africa primate viruses than to HIV. What makes sense is that SIVmac is actually a virus of African origin brought over generations ago by captured African primates, and the Rhesus macaque monkeys were exposed to this African virus by living in close proximity to these African species within the cages of the U.S. research facility.

In truth, HIV stands alone among the primate viruses. All the other primate retroviruses are clustered together; having approximately 75% homology. HIV stands off to the side with 50% homology. However, HIV shares 40% – 50% homology with a set of well-characterized, pathogenic (disease-causing) retroviruses; namely retroviruses that infect ungulates (animals with hooves): horses, goats, sheep, and cattle.

Before HIV and the African primate fiasco, most known retroviruses were infectious agents that caused disease in the aforementioned animals of economic interest. At the advent of HIV, virologists working with these animal viruses attempted to draw parallels between these pathogenic animal retroviruses HIV. This comparison was easy to make because some of these animal viruses and HIV shared biological infectious processes, such as the induction of syncytia (a massive cell created by the fusion of many cells) and neurotropism (the ability to infect brain cells). (Retroviruses are also found in birds, mice, rats, pigs, and felines – both house cats and lions. Since the advent of HIV, many retroviruses under study have been renamed “immunodeficiency” viruses.)

But the theory that HIV and AIDS originated somewhere “way over there” was more palatable than any research that might associate HIV and AIDS with food and ranch animals. Which, in part, brings us to our current status of misconception.

Chris Jennings

HIV/AIDS Analyst

Publications:

• The HIV/AIDS Biological Primer

• HIV/AIDS – The Jennings Report: Redefining the Size, Scope, and Scale of the AIDS Epidemic by Forensic Review of the Medical Literature

• HIV/AIDS Statistics in the Republic of South Africa (RSA): An Analysis of HIV/AIDS Mortality comparing Death Counts, Surveillance Data, and Modeled Estimates

For More Information: www.healthalert.net

The country’s AIDS prevalence is widely considered to be of epidemic proportions. WHO/UNAIDS statistics suggest hundreds of thousands of deaths each year in the state alone, so it follows that substantial research funding is being pumped into drug development by corporations, governments and philanthropic bodies alike.

Health Alert‘s new report HIV/AIDS Statistics in South Africa, however may turn existing policy towards the treatment of the disease on its head. The report challenges the assumptions underlying global estimates for the prevalence and distribution of HIV; raising further questions as to the actual market size for products related to treating infection.

Estimates from UNAIDS abound that the Republic of South Africa had 360,000 HIV/AIDS deaths in 1997, new tabulated surveillance data indicates only 6,635 deaths were actually attributed to HIV/AIDS.

UNAIDS also estimated that the country had 2.9 million people living with HIV/AIDS (PLWH) in the same year. Even given the 11-year survival period a substantial cluster of those individuals should have died by 2008;  however the county  tabulated a total of 136,000 HIV/AIDS deaths for the 11 years 1997-2008 inclusive, a figure far less than estimates would lead us to expect.

Report author Chris Jennings said ‘One problem is that epidemiological models incorporate a misconception about the HIV incubation period.

‘At the outset of the AIDS epidemic, the Centers for Disease Control actively tracked and interviewed patients, and determined that HIV incubation averaged 8- 18 months. Fifty percent (50%) of these patients died within 12 months of manifesting opportunistic infection. Therefore the first AIDS deaths occur 20 months after infection, not 10 years as currently conceived; changing the distribution curve’.

The surveillance data has been inputted into Computer models using specific algorithm’s to generate the results.

Health Alert report that pharmaceutical companies invest $300 million into developing anti-retroviral drugs thanks to an over-estimated market, but the most threatening diseases to mortality in the third-world; pneumonia, diarrhoea and tuberculosis, receive only marginal funding by comparison.

The organisation is not alone in its claim that the disease has been lent a disproportionate weight in terms of global policy and attention.

In establishing its own off-shoot agency UNAIDS, the UN has treated HIV ‘like an economic sector rather than a disease’, Roger England, chair of small Grenada-based think tank Health Systems Workshop, commented.

Health Alert challenges the common statistics oft cited by the UN with regards the epidemic in the country;

‘The supposed HIV seroprevalence rates in the Republic of South Africa exceed all plausible limits of heterosexual HIV transmission,’ states Jennings.

He continues that the ‘scale and scope of the epidemic have been grossly distorted in the RSA and other indigent, tropical settings’, suggesting that ‘theoretically, the heterosexual African black men of the Republic of South Africa would have to sleep with 5 – 20 times as many sex partners as the gay men of NYC in order to instigate a geometrical AIDS growth pattern equalling that in the United States at the start of the AIDS epidemic’, re-iterating that the global epicentre for the disease remains New York City.

Whilst it is hugely important to maintain an accurate grasp on seropravalance, there is also the risk that these explicit statements may feed the arguements of ‘AIDS denialists’ in the country. For many years under Thabo Mbeki’s presidency, the prevalence of HIV was widely disputed at high levels of government, with dietary remedies recommended over anti-retroviral drugs. Accurate data is crucial in the successful treatment of the disease and healthcare provision in the county, so it is hoped any policy changes following this research will serve to benefit the sufferers.

www.healthalert.net

Tablets carrying a reference of ‘batch number E100766’ were previously identified as fake, and WHO has now confirmed batch numbers A9351, A9357, A9366 or E110467 also fall under suspicion.

Whilst genuine batches with numbers E100766 and E110467 were never supplied to the Kenyan market at all, those with reference to ‘batch number A9351, A9357 or A9366′, exceed the quantities made, packed and dispatched by the manufacturer, Hetero Ltd of India.

Genuine Zidolam-N is a combination of three popular anti-retrovirals – Lamivudine, Zidovudine and Nevirapine. The counterfeit medicines showed evidence of discolouration, deterioration and re-labelling.

The organisation has called for individuals who may have received a contaminated prescription to seek immediate medical advice, and even though no falsified tablets have yet been found outside of the country, they have advised increased vigilance against counterfeit drugs from countries neighbouring Kenya.

Authorities are now investigating whether diversion of the medicine has occurred.

Despite the country affirming their commitment to Human Rights and Maternal care, the advocacy group have called for ‘necessary steps to abolish the death penalty in national legislation and to commute existing death sentences to terms of imprisonment’ said Brima Sheriff, director of Amnesty Sierra Leone.

The Human Rights Council is to adopt the Universal Periodic Review outcome on the country.

Thirteen states raised the issue of the death penalty during the review, calling for a moratorium on executions, abolition of the death penalty, and ratification of the Second Optional Protocol to the International Covenant on Civil and Political Rights.

The group also want the country to reinforce transparency and accountability by monitoring and investigating shortcomings in the national health systems, and to respond robustly to allegations of corruption and systematic malpractice.

The organisation has also urged authorities to establish complaint mechanisms within the health systems and inform patients about their right to redress.

The country must also commit to conducting a periodic assessment of progress using ‘UN process indicators’ to monitor the availability, utilization and quality of emergency obstetric care.

Amnesty published a recent document stressing the ongoing challenges faced by pregnant women and girls in Sierra Leone. They report that drugs and other essential medical supplies are often unavailable at health facilities, or they are charged for free care.

Their research has also brought to light serious deficiencies in accountability across critical areas of the health system.

The move to improve healthcare in connection with birth delivery and address maternal mortality, healthcare policies and family planning was also welcomed.

The partnership will provide grants to Rotary clubs and districts to assemble vocational training teams of medical professionals. These teams will collaborate with charity Mercy Ships’ medical staff to perform or assist in life-altering surgeries. Their expertise will be shared with the local communities through training programs aimed at enhancing healthcare professional’s skills.

Mercy Ships currently operates the largest non-governmental hospital ship in the world to deliver free, world-class health care services, capacity building and sustainable development to those without access in the developing world.

‘Mercy Ships is honored to be chosen as a strategic partner for Rotary’s focus on disease prevention and treatment,” said Mercy Ships President and Founder Don Stephens. “The scope of Rotary’s service to humanity is truly monumental, and it is my belief that the synergy of our organizations working together will be an even greater force to improve health care delivery systems in West Africa.’

Health care training and skills building for local hospitals is a major focus for Mercy Ships. They will collaborate with Rotary to attract members from all over the world to help provide vocational training to surgeons and ancillary staff on the Africa Mercy, Mercy Ships flagship, as well as in local hospitals and facilities.

The first focus will be West Africa where the Africa Mercy is presently based in Freetown, Sierra Leone. The Africa Mercy is an ideal training platform with a controlled environment and a steady flow of patients.

Grants will be disbursed in the coming months, with the first Rotary teams expected to be in West Africa by early 2012.

‘The need for top quality health care is great throughout West Africa, where far too many families lack access to hospitals, doctors nurses, dentists and other health professionals,’ said Rotary Foundation Vice-Chair Sam Okudzeto of Accra, Ghana.

‘Daily, we learn of expectant mothers and children dying from ailments that can easily be cured if health facilities are available.The partnership between Rotary and Mercy Ships leverages the strengths of both organizations to significantly address this disparity between need and access. I am sure many lives will be saved and quality of life will improve by this intervention.’

The moves are a major development in protecting children from contracting deadly illnesses diarrhoea and pneumonia, the two leading child killers.

Sudan has already begun the rotavirus process, and the announcement confirms that 12 of the countries to profit under the scheme are African. Rotavirus is the foremost cause of severe diarrhoea in children under five years of age, killing more than half a million children annually worldwide and causing illness in several million more. Nearly 50% of all rotavirus deaths occur in Africa, where access to treatment for severe rotavirus diarrhoea is limited or unavailable.

GAVI reports a marked increase in vaccine applications, and are clearly working hard to provide greater protection for children in developing nations. Out of the 37 countries that have applied for vaccine funding from GAVI, an astonishing 24 of those approved are in Africa.

‘Thanks to our donors and partners, the GAVI Alliance is now delivering on its promise to protect more children across the developing world against rotavirus, pneumococcal disease and other life-threatening yet preventable diseases,’ said GAVI CEO Seth Berkley M.D.

‘The death toll of rotavirus and pneumococcal infections in Africa is particularly devastating, and this is where these vaccines will make the most significant impact, not only in lives saved, but also in terms of healthy lives lived,’ he added.

‘Immunisation enables good health and healthy people are more productive and ultimately fuel economic growth.’

Rotavirus vaccines have proven to be highly effective at reducing chronic and fatal diarrhoea and have saved thousands of children’s lives. Recent studies show the rapid and considerable impact of rotavirus vaccines to reduce child deaths and improve children’s health.

For example, prior to the introduction of the vaccines in Mexico in 2006, 50% of deaths due to childhood diarrhoea were caused by rotavirus. The country has since seen a remarkable 46% reduction in the number of children under age five dying from diarrhoea.

‘Inmates can suffer permanent damage to their physical and mental health as a result of their incarceration and most haven’t even been convicted of a crime – they’re simply waiting for a trial date.’ said Amnesty International’s Tawanda Hondora

A lack of running water and chronic overcrowding in certain prisons has a serious effect on the health and safety of prisoners. Liberia’s largest institution Monrovia Central Prison was designed to hold 374 inmates, but during Amnesty International’s visit in July it was well over capacity with 839 prisoners in total. One block housed up to eight men per 2×3 metre cell, with only a small window for ventilation.

“In some cells there isn’t room for all inmates to lie down at the same time so they sleep in shifts,” said Tawanda Hondora

Another major concern was the lack of healthcare provision for inmates. Prisons struggle to deliver medical care because of a lack of trained staff and essential drugs. Common conditions such as malaria, skin infections and eye problems frequently go without treatment and inmates are only moved to hospital in an emergency.

Liberia’s internal armed conflict finally ended in 2003, and since then the government has made major progress in its efforts to overcome the legacy of the conflict. President Ellen Johnson-Sirleaf and other key government officials have pledged their commitment to change and are trying to implement judicial reform.

The Liberian government, in collaboration with development partners, have taken several positive steps such as improving sanitation in Monrovia Central Prison and including prison health services in a 10-year national health and policy plan. However much more needs to be done before the state meets Prisoners’ fundamental needs.

‘In all circumstances the government has a clear and binding obligation not to expose prison inmates to conditions that constitute cruel, inhuman and degrading treatment,’ said Tawanda Hondora.

‘Immediate action is needed to improve conditions, including access to health care, for Liberia’s prison inmates.’

The campaign unites a number of NGO’s and charitable organisations including Fair Play for Africa, Oxfam, Treatment Advocacy, 24-10, Media Life Movement, Zambia Social Forum and Women For Change. The group are calling on would-be councillors, parliamentarians, and presidential hopefuls to pledge to an improvement to healthcare delivery. They specifically want higher level leaders to interact with the electorate in order to learn more about the health issues affecting their constituencies. They also want them to sign a pledge to vow they will;

Ensure that government commits to increasing the health budget to at least 15 per cent in accordance with its commitment to the Abuja Declaration, with greater transparency and accountability in planning and spending

Ensure an increase in the number of health facilities and clinics, that they are staffed with adequate numbers of trained health workers providing appropriate health information to the public and are stocked with essential medicines and drugs.

Ensure that health is included in the Constitution’s Bill of Rights as one of the fundamental human rights.

Ensure increased access to quality health services, including among other measures the abolition of user fees in urban areas

Healthcare was made free for all patients in rural, remote areas in 2006 (the year of the last presidential and parliamentary election), however the health service faces ongoing obstacles such as funding cuts, lack of crucial medicines and a shortage of skilled workers, meaning those who need it most are often forced to go without or pay for their treatment.

Felix Mwanza, national co-ordinator for Treatment Advocacy, said; ‘We acknowledge the significant milestones the government has reached in improving healthcare facilities, nonetheless, there are still many challenges such as lack of access to health services, under-staffed health centres and user fees to mention a few’.

If following this week’s polls he should succeed in securing another term, will President Rupiah Banda and his ruling Movement for Multiparty Democracy (MMD) make the requisite moves to improve conditions for the rural population? With a similar set of priorities to his contenders, it seems whoever wins will have a task in implementing the change that young Zambian’s so desperately want. Primary opposition and leader of the Patriotic Front (PF), Michael Sata has cultivated an image of champion of the poor, but it seems likely that if he delivers on his promises to nationalise industry and restrict outside investment from economic superpowers such as China, further cuts on the domestic front will follow.

Uganda is one of eight countries where Idasa-GAP, with local partners, has been collating information on the regional impact of HIV and AIDS. Research has focused upon the potential of local government institutions to deliver the services expected by its citizenry, local perspectives of financing and spending towards HIV and AIDS, and AIDS-induced exclusion from social, political and economic life.

The conclusions were presented at a consultative meeting in Uganda’s capital Kampala on 13 September, with politicians, government officials and civil society organisations from the HIV/AIDS and governance sectors in attendance. Keynotes speaker and country director of the Alliance of Mayors and Municipal Leaders on HIV/AIDS in Africa (AMICAALL), Dr John Mugisa, said good governance was central to responsive HIV and AIDS governance.

‘As long as responses developed at the national level are not operational on a local level we will not move forward in responding to the needs of ordinary citizens affected by the epidemic.’ he said.

The data also points to several systemic and structural challenges facing local governments, like inadequate capacity to manage local affairs and to cope with the new demands emerging from HIV and AIDS related services. The report notes that some leaders lack the experience and skills to handle the ‘dynamics and complexities’ of HIV and AIDS.

Whilst the findings are hugely encouraging and represent a changing attitude towards AIDS and HIV in the country, Uganda’s past elections have been characteristically dogged by allegations of rigged elections, voter intimidation and media bias; so it is unclear whether these views will be reflected in future polls.

In a press release, the organisation called for the Kenyan Government; ‘to ensure credible independent investigations into the causes of the incident and take action on the outcome of the investigation to ensure that such incidents do not take place in the future and put in place safeguards to prevent further leakages and accidents.’

The blaze was caused by the explosion of a petrol pipeline which runs adjacent to the settlement, known as Sinai. The precise source has yet to be established however it is thought that it may be related to a petrol leak which seeped into an open sewer, as a police spokesman confirmed that fuel had leaked from a tank in a nearby depot.

The sprawling informal settlement, located in Nairobi’s industrial region, is thought to have suffered significant damage. Amnesty are now appealing for immediate aid from the Kenyan authorities, including the Nairobi city council, to provide emergency assistance such as food and water as well as housing for those whose homes have been destroyed.

The potential risk to inhabitants still residing in the slum has been addressed by certain officials, even allegedly the Prime Minister, suggesting residents vacate the area. However, while people may have to be moved rapidly for reasons of safety, Amnesty express concern that this cannot be used to justify leaving people homeless in the wake of such a disaster.

This recent blaze is one of a string of fires this year to have highlighted the vulnerability of Nairobi’s slum dwellers.

Fire can spread rapidly in such settlements due to overcrowding, the construction of settlements themselves and their proximity to hazardous areas. On 8 March a fire destroyed 80-90% of the Deep Sea informal settlement in Westlands, which according to the Kenya Red Cross injured or displaced up to 10,000 people.

Along with requesting emergency relief in the aftermath of the disaster, Amnesty International is now addressing what can be done to prevent future incidents and are urging the Government to tackle the insufficient and frequently perilous conditions in slums, as well as increase fire safety in such areas by providing information to residents and improving the roads to enable access for emergency service vehicles. These measures they say, must be implemented in order to make certain ‘that all persons are able to enjoy the right to live in security and dignity’.