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AIDS
IN AFRICA
One vocal skeptic of the
role of HIV in AIDS argues that, in Africa, AIDS is nothing more than
a new name for old diseases (Duesberg, 1991). It is true that the
diseases that have come to be associated with AIDS in Africa--wasting,
diarrheal diseases and TB--have long been severe burdens there. However,
high rates of mortality from these diseases, formerly confined to
the elderly and malnourished, are now common among HIV-infected young
and middle-aged people (Essex, 1994). In a recent study of more than
9,000 individuals in rural Uganda, people testing positive for HIV
antibodies were 60 times as likely to die during the subsequent two-year
observation period as were otherwise similar persons who tested negative
(Mulder et al., 1994b). Large differences in mortality were also seen
between HIV-seropositive and HIV-seronegative individuals in another
large Ugandan cohort (Sewankambo et al., 1994).
Elsewhere in Africa findings
are similar. One study of 1,400 Rwandan women tested for HIV during
pregnancy found that HIV infected women were 20 times more likely
to die in the two years following pregnancy than their HIV-negative
counterparts (Lindan et al., 1992). In another study in Rwanda,
215 HIV-seropositive women and 216 HIV-seronegative women were followed
prospectively for up to four years, during which time 21 women developed
AIDS (WHO definition), all of them in the HIV-seropositive group.
The mortality rate among the HIV-seropositive women was nine times
higher than seen among the HIV-seronegative women (Leroy et al.,
1995)
In Zaire, investigators
found that families in which the mother was HIV-1 seropositive experienced
a five- to 10-fold higher maternal, paternal and early childhood
mortality rate than families in which the mother was HIV-seronegative
(Ryder et al., 1994b). In another study in Zaire, infants with HIV
infection were shown to have an 11-fold increased risk of death
from diarrhea compared with uninfected children (Thea et al., 1993).
In patients with pulmonary tuberculosis in Cote d'Ivoire, HIV-seropositive
individuals were 17 times more likely to die than HIV-seronegative
individuals (Ackah et al., 1995).
The extraordinary death
rates among HIV-infected individuals confirm that the virus is an
important cause of premature mortality in Africa (Dondero and Curran,
1994).
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