THE POLITICAL ECONOMY OF AIDS Part 2

[Guest guest]

THE POLITICAL ECONOMY OF AIDS Part 2

 

A quick review of some basic information about the link between

immunosuppression and historic endemic conditions and diseases underscores the

importance of focusing on socio-economic factors in the prevention and treatment

of chronic life-threatening immunodeficiency.

 

o HIV is not the only viral marker of profound immunodeficiency, nor is it the

most common. Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) are at least as

common, and usually antecedent to HIV, and all three are virtually always found

in combination with at least some of a host of other concomitant infections long

endemic in the Global South, and increasingly common among the poor in

industrialized countries, including:

… Herpes simplex virus, hepatitis B virus (HBV), and human T cell lymphotropic

viruses (HTLV - also associated, for example, with leukemia);

… Mycobacterias (associated with tuberculosis, leprosy, and complications of

pneumonia, hepatitis, diarrhea and dementia);

… Mycoplasmas (non-specific immunosuppression, and complications of pneumonia

and proctitus);

… Candida and other fungal and yeast infections (Cryptococcus, Trichosporon,

Histoplasmosis, Blastomyces, Coccidioides and Aspergillus species);

… Various parasitic diseases, including trypanosomiasis (sleeping sickness),

Plasmodia (malaria), helminths (parasitic worms such as nematodes, flatworms,

tapeworms and roundworms), filariasis (worm causing elephantiasis, among other

things), and other parasitic infections, such as Cryptosporidium species (causal

agents of severe and prolonged diarrhea);

… Bacterial infections, especially sexually-transmitted diseases (notably

syphilis, gonorrhea, chancroid and chlamydial infections), and pyogenic

(pus-producing) and septicemic (blood) infections (often related to, among other

factors, intravenous drug abuse and septic medical treatment);

… Protozoan infections, especially Pneumocystis carinii (causing pneumonia),

Toxoplasmosis (associated with dementia), and Entamoeba and Giardia lamblia

(causing amebiasis and giardiasis, resulting in severe chronic diarrhea);

… Diabetes.

 

o Parasites such as helminths, and parasitic infections such as trypanosomiasis,

schistosomiasis, amoebiasis, and giardiasis not only in and of themselves cause

significant immune suppression, but also increase the risk of anemia in pregnant

women, which in turn increases the risk of low birth weights and malnutrition in

newborns; in addition, these infections are often transmitted from the mother to

the unborn child, jeopardizing the infant immune system independently of other

risks.

 

o Malnutrition is universally prevalent in countries and regions identified as

" epicentres " of AIDS. Malnutrition is known to critically increase

susceptibility and vulnerability to parasitic infections and their effects. As

well, the profound immunodeficiency that accompanies acute under-nutrition leads

- as result, for example, of even small deficiencies of critical nutrients such

as Vitamin A - to a marked increase in mortality during other infectious

disease.

 

o Pneumocystis carinii pneumonia (PCP), one of the supposedly rare diseases that

most definitively marked the onset of AIDS in North America, is neither new nor

so very rare. Identified in 1911, vulnerability to PCP is related to, among

other things, prolonged Vitamin A deficiency in drug addicts and alcoholics, and

has been commonly diagnosed among the malnourished in the Global South,

particularly among young children in Africa and Asia suffering from Kwashiorkor.

(Root-Bernstein pointedly asks, " Why do we call a patient who dies of

Pneumocystis pneumonia [independent of HIV] unfortunate, but one who dies of

Pneumocystis pneumonia and HIV an AIDS tragedy? " )

 

o There is a similar history with respect to other infections, such as systemic

Candida fungal (yeast) infections, now one of the most prevalent opportunistic

infections associated with AIDS, but to which people with calcium deficiencies,

general malnutrition and diabetes have always been at particular risk.

 

o In tropical Africa, diagnosed AIDS has been concentrated almost entirely in

regions where malaria has long been endemic. Studies in South America and Africa

indicate that malaria infection (and several other infections, including

tuberculosis) triggers the same basic immune response, resulting, even in the

absence of HIV, in clinical seropositivity on the tests used (ie. " false

positive " results).

 

Root-Bernstein points out that children who survive malaria are still often

iron-deficient and immune-suppressed due to malaria-associated anemia, commonly

treated by blood transfusions (in one year he studied, for example, almost 70%

of the 13,000 transfusions performed at Mama Yemo Hospital in Kinshasa were

given to children with malaria). Not only are blood transfusions in themselves

profoundly immunosuppressive, but the transfusions also carry the risk of

transmitting the most common infectious viruses (eg. Hepatitis B, CMV, EBV,

HLTV). In addition, malaria and other parasitic infections such as

schistosomiasis and filiariasis themselves cause immune suppression, as do most

of the antimalarial and antiparasitic drugs which are commonly used, and

over-used, to treat or prevent these diseases.

 

o Sickle cell anemia, common in black equatorial Africans, and some other

populations, is a genetic hemoglobin defect which, while detrimental to oxygen

transport, incidentally protects against malaria. As with malaria, blood

transfusions are a common treatment for sickle cell anemia, and the recipients

are vulnerable to the same risks, both from the immunodeficiency induced by the

anemia and blood transfusions, and the potential of infections transmitted by

the blood transfusions themselves.

 

o Kaposi's Sarcoma (KS), long considered by North American doctors to be a rare

condition, was the first opportunistic disease associated diagnostically with

AIDS. Root-Bernstein demonstrated that in fact KS, along with Burkitt's

lymphoma, has been endemic at high rates in central African countries

(representing almost 10% of all cancers) for at least as long as records are

available, since the mid-1950s. Particularly notable are the high rates of

Kaposi's Sarcoma in African children in these regions, especially those

suffering from malaria. Bernstein also reports theories linking malaria and

Epstein-Barr virus as co-factors in Burkitt's lymphoma, whose sufferers exhibit

symptomatic conditions similar to AIDS.

 

In the mid-90s, after the original publication of Root-Bernstein's book, it was

publicly confirmed by the U.S. Centers for Disease Control that Kaposi's Sarcoma

- the original AIDS disease that led to the invention of AIDS as a construct -

is not caused by HIV at all. Scientists working independently of the AIDS

researchers had conclusively identified another virus as the source of KS,

sometimes erroneously referred to as the Kaposi's Sarcoma virus, but actually

related to Human Herpes Virus-8.

 

In spite of this revelation, to this day most doctors and AIDS activists

continue to associate Kaposi's Sarcoma with HIV and AIDS, especially in the

African context. Not incidentally, some evidence has been recently marshalled

that acute immunosuppression may also be brought on by Human Herpes Virus-6, a

hypothesis also being ignored by the mainstream of AIDS science.

 

In addition to the synergistic interplay of this host of endemic conditions,

diseases and infections prevalent in regions with a high risk of chronic

life-threatening immunodeficiency, there are similarly a plethora of other known

agents of critical immunosuppression which interact dynamically with each other,

and with the endemic pathologies we have listed. These include:

… human semen, when introduced to the bloodstream;

… chronic high-dose use of virtually all addictive and recreational drugs

(including cocaine, heroin, morphine, codeine, amyl and butyl nitrates,

marijuana and alcohol);

… chronic use or acute high dosages of common pharmaceutical agents, especially

antibiotics, including the common drugs such as penicillins, chloramphenicol,

tetracycline, streptomycin, kanamycin, gentamycin, neomycin, among others, as

well anti-virals (such as acyclovir, ribavirin, retrovir and zidovudine -

" AZT " ), and antimicrobials (such as trimethoprim, sulphonamides, pyrimethamine);

… antiparasitics used to treat parasitic worms, protozoa and amoeba so common in

the Global South (particularly antiparasitic imadozole drugs such as

Clotramizole and Ketoconazole, and many of the antimalarials, especially

chloroquine);

… steroids (for example, cortisone, used to treat asthma, rheumatism and

arthritis, and corticosteroid creams, used to treat inflammation caused by

various venereal infections, such as herpes simplex); one of the critical

factors in the lung disease that ultimately kills so many AIDs victims - and

more recently many victims of SARS - as well as long-term cancer patients, is

the use of corticosteroids which can destroy the lungs' capacity to breathe

efficiently and effectively, or to resist pneumonias;

… psychotropic agents and tranquillizers (especially chlorpromazine, imipramine,

phenothiazines, and their various derivatives, whose chronic use has been

long-associated with oral candidiasis, high rates of pneumonia, and other severe

infection).

 

o In addition to pharmaceuticals, other conventional medical interventions

inevitably have an effect on the body's immune capacity. Anesthesia is a

profound immunosuppressant, as is surgery itself. Few interventions are as

immunosuppressant as a blood transfusion (quite aside from the risk of

incidental viral infection), and sustained periodic or regular blood

transfusions cannot help but lead to chronic immunodeficiency. Virtually all

hemophiliacs, who require regular transfusions and infusions of blood products

to control an inherited condition in which blood clotting is impaired, are at

permanent risk of chronic immunodeficiency, regardless of the presence of HIV or

other common viral markers of AIDS.

 

Finally, and in the light of all this information, the rarely-publicized but

well-documented problem of the " antibiotic epidemic " in the Global South can

only make more frightening the already endemic risks of chronic life-threatening

immunosuppression. The widespread and indiscriminate over-the-counter black

market trade in antibiotics, the pervasive self-treatment of incidental and

chronic infection, and antibiotic treatment administered by self-ordained local

" doctors " , on their own are capable of creating serious and pervasive

immunosuppression among populations where these virtually ubiquitous practices

exist.

 

None of the information presented here is new. This is particularly the history

of the poor, not only in the Third World, but also in North America where by far

the majority of diagnosed AIDS, and of undiagnosed immunodeficiency, occurs

among the poor, the socially marginal (particularly ethno-minorities), and the

derelict.

 

The clear implication is that the preponderance of chronic life-threatening

immunodeficiency is related to long-standing social and endemic causes other

than HIV. Even among the more affluent - other than persons who are at risk due

to specific conditions (eg. hemophilia, sickle cell anemia, malaria) or

treatments (eg. transfusions, long-term use of certain pharmacological agents) -

immunodeficiency occurs virtually exclusively among people who have created in

their lifestyle many of the critical risk elements (addiction and drug abuse,

poor nutrition, chronic infections, including STDs, and antibiotic use) usually

associated with poverty. They have developed an " impoverished " immune system in

an affluent body.

 

Dr. Root-Bernstein points out that the presence of HIV is not a pre-condition

for clinical AIDS diagnosis in Africa and other parts of the Third World, and in

the large majority of cases worldwide it has not even been tested. Many people

of course will ask on what basis, then, AIDS is diagnosed. The answer is that

the diagnosis of AIDS remains largely arbitrary. As clarified at the outset,

AIDS is an ever-shifting medical construct with an expanding list of over 30

associated diseases. Called " opportunistic infections " , these are diseases -

none of them new - which when contracted can lead to a diagnosis of AIDS.

Increasingly even diseases not officially listed - most particularly

tuberculosis - are casually designated as " HIV-related " . Usually, the diagnosis

of AIDS is offered in spite of several serious prior immune-compromising

conditions which, in fact, make the AIDS diagnosis redundant and superfluous.

 

AIDS is a conceptual basket into which an increasing number of these common

conditions have been dumped, then the lid put over top and the basket itself

counted as one disease. This has obscured the nature, complexity and possible

remediation of the individual conditions while offering no benefit whatever to

those suffering these conditions who, to the contrary, are now presumed to be

dying and beyond cure.

 

Discussing the ever-changing and expanding definition of AIDS, Root-Bernstein

argues that ongoing definition alterations are " social and economic, not

scientific " , sharing Erik Eckholm's analysis from the New York Times that " the

definition [of AIDS] has become a political as well as a medical question " .

Root-Bernstein explains how the incidence of AIDS can suddenly multiply " by

definitional fiat " . He concludes,

....a significant proportion of the continued explosive growth of AIDS has been

fueled not by the transmission of AIDS to new groups of people, but rather by

the inclusion of previously excluded groups of people into the category of

AIDS...One could justifiably argue that the AIDS epidemic is due at least

partially to the grouping of two dozen causes of death under one rubric rather

than to a new disease.

 

This has grave implications in areas of the Global South where any or all of

these pre-existing debilitating and often deadly infections are endemic, and

chronic immunodeficiency from social causes, most notably malnutrition, has been

a blight since long before the " discovery " of AIDS.

 

The perception of AIDS as one overwhelming disease has been very influential in

regard to how AIDS is dealt with everywhere in the world. This is particularly

so in the Global South, as governmental aid donors, multilateral organizations,

and the international non-government sector participate in promoting and

implementing AIDS programs in virtually every country.

 

We have seen a diversion of attention worldwide from the chronic problems caused

by the conditions of poverty, war and repression - realities that kill literally

tens of millions every year. The growing amount of international aid money

devoted to AIDS related programs has skewed health funding to the extent that

the preponderance of all health spending in Africa now goes into AIDS programs,

and obscures other development issues that demand critical attention.

 

The AIDS model has not merely impacted the emphasis of funding but has also

influenced the way that health care is carried out. We have seen the practice of

medicine skewed, to the detriment particularly of the weakest and most

marginalized, and to women. Under the belief that HIV and AIDS are inevitably

terminal, many people in the global south suffering from various endemic

conditions are left without appropriate treatment, in a cruel system of triage

that ultimately confirms the prophesy - they die, unattended. The diagnosis of

AIDS is deadly, not necessarily because of the illness but because of the

treatment that follows from the diagnosis itself, including the stigma and

social isolation that flows from the constant association of HIV/AIDS with

illicit and " perverted " sexual practices.

 

 

 

 

 

 

 

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