Reported cases of AIDS to WHO, supports the earlier record that AIDS appeared in Africa after 1980.
Epidemilogical survey of African reported AIDS cases strongly support the hypotheses that AIDS pandemic
started in USA.
Summary: By using the cumulative cases of AIDS reported from the national health authorities in 20 African countries to the WHO central office in Geneva their trends were evaluated. The patterns of the African countries were also compared with some other countries using a linear-logaritmic method. With this method one may easily make the conclusion that the years of origin of the epidemic, given earlier for the different countries are valid. That means AIDS started in Uganda in 1982. For Congo, Kenya, Rwanda, Zaire and Zimbabwe the first year is 1983. Burundi, CAR (Central African Republic) and Tanzania had the start of their national epidemic in 1984. In Botswana, Cameroun,Cote d´Ivoire, Ghana, Malawi, Mocambique and Zambia it started in 1986. In Ethiopia, Gabon, Nigeria and Togo it started in 1987. With a few exceptions ( Cote d´Ivoire, Ghana, Malawi and Zambia) these earlier reported years are consistent with the epidemiological records reported to WHO from 1986 to 1994. But even for the exceptions the delay in reporting is just within a time limit not exceeding two years.
This means AIDS started as an epidemic in USA in 1978-79, and the numerous speculations about an African origin are still without substantial scientific support.
Methods: The reported cumulative figures of AIDS published in the WHO epidemiological records from 1986 until january 1994 with their respective reporting date were plotted into a logaritmic-linear diagram, where the number of patients are on the vertical logaritmic scale and the dates on the linear scale. From the Panos dossier: ¨AIDS and the third world¨ the reported year of the first case to appear was taken. (Here USA was an exception since they reported 1969 as the year of origin. Instead the cases appearing in New York 1978-79 were used since they were connected with an epidemic.)
For comparision five non-African were chosen: USA, Brazil, France, Sweden and Thailand. Among the total of 25 countries, 11 were available with statistical numbers which even covered the very few first cases and where there was no doubt how and when the first cases appeared. They were four of the non-African states (Brazil excluded) and among the African states: Botswana, Cameroun, Ethiopia, Gabon, Mocambique, Nigeria and Togo.
These 11 countries showed a full epidemiological pattern, from the very beginning of the epidemic until the recent situation (January 1994).
Due to a restricted economical situation, the first cases in the other African countries could not during the years 1982-85 be confirmed being caused by HIV both clinically and laboratorically. Before 1985 there was even no easy serological testing method. Thus a more expensive T cell count must be applied to confirm the clinical observation. But for the countries which got their first cases 1986, or after, this difficulty was not present. Thus, they may guide in an epidemiological evaluation.
For the following evaluation and discussion the diagrams must be studied.
Evaluation and discussion: The pattern shown is usually a very rapid increase in the beginning. The first two-three years showing a slope close to a six-month-doubling rate. In a few cases, most pronounced for Thailand, it started somewhat slower, until around 1990 when the strong increase appeared.
For the other countries the first cases all appeared among patients which had a high number of sexual relations, either they were liberal gays, intravenous drug abusers or heterosexual prostitutes or their customers. The conclusion can easily be made: As soon as the virus enters into a sub-group of a country that exhibit a multi partner sexual habit, the epidemic will gain speed. Thus the virus can´t be hidden within a population for a long time until this happen.
Also noted are that some, although few patients develop AIDS within a short time after primary infection. Instead of the normal time of the asymptomatic period ranging from three to twelve years, there are always some that develop clinical signs almost without any latency at all, i.e. within a few months after being infected and consequently being diagnosed as AIDS patients.
It must be considered probable to assume that the first patients to be recognized with AIDS in a geographical area are those who belong to this pattern of the HIV-infection with a highly reduced or absent latency. Thus the assumption must also be made, that even the virus couldn´t be present for a long time until a patient appeared, unless the HIV-carriers belonged to a sub-population that had very restricted sexual traditions and very few contacts with neighbouring ethnical groups.
The latter is also consistent with the fact that no single country has succeeded into containing their epidemic into a steady state.
After the first rapid introduction, there are observed a more or less pronounced bend in the logaritmic graphs. For USA this happened in 1984. In France 1989. In Sweden 1988-89. In Kenya 1989. In Congo 1987. In Togo 1991. In Cote d´Ivoire 1991. In Africa as a continent in 1989. After this bend the doubling rate comes closer to two-three years. This bend may to some extent for African countries contain an unsecurity within a range of one to two years, due to a changed diagnosing criteria, changed reporting systems or delays in reports. Obviously there are a few plots which are deviations from the graphs, but they are merely exceptions.
At what number of patients the bend is to appear may be discussed. The total population of the country is of interest, but probably the number of people that belong to a sub-group which has a promiscous sex life style, either homosexual or heterosexual, is of more importance. Also the immunological state or health of the population must be taken into account. Here the average protein intake must play a role, since the maintaining of a high production of anti-bodies, which themselves are proteins, seem to be of great value to resist being infected or to extend the asymptomatic period. This last assumption may explain the differences between the epidemiological patterns for industrialized countries and third world countries, where the latter seem to rise their graph higher before the bend occur. Thus the main explanation that e.g. Sweden and France, although they got their start of the AIDS epidemic before African countries, by now (1994) have been passed by many African countries, is a question of economics, where the unequality in terms of trade is the underlying reason. Besides a low average protein intake for most Africans, the economic situation forces a great proportion of young females into prostitution, just to contribute to the maintenance of living conditions for their extended families.
There is one abnormality observed in 1992-93, concerning two countries, Ghana and Cote d´Ívoire. During these years Cote d´Ivoire has got a very peculiar drop in their slope, even lower than France, whereas neighbouring Ghana, although it has got a medium total population still is rapidly increasing. This could be explained by the tradition that many young Ghanaian women go abroad for sex trading. Many of them compete with the Ivorian girls in Abidjan, are infected with the virus and as soon as they come down with clinical signs of AIDS they are deported. At their return back to Ghana they are part of the Ghanaian statistics. Thus the Ghanaian AIDS statistics are to a great extent mirroring the spread of the HIV infection in Cote d´Ivoire. Thus one could state that the tip of the Ivorian AIDS-berg is showing up in Ghana.
From the WHO head office, in their bulletins they often state or speculates in a heavy underreporting of AIDS from African countries. In January 1994 they estimated there was 2 millions cumulative AIDS cases in Africa, although the total reported number was 300 000. Their AIDS estimation was calculated outgoing from the seroprevalence figures, taken at different occasions in hospitals, among prostitutes etc, and then compared to the total population. In all, they assumed 9 million were HIV positive in the end of 1993 in the continent of Africa.
But the method used in this article, can reduce the problem. Let us assume e.g. that Sweden actually is reporting only 10% of her real number of cases. In the diagram this is equal to lifting the Swedish graph. That means that the plot of 1986 =100, will reach 1000. The end of 1993 plot =1000 will reach 10000 etc. But what about the year of the start of the epidemic? Due to the very steep slope in the beginning, the starting point of the epidemic will only be moved approximately 1,5 years to the left. In that case the first patient seemed to have appeared sometime in 1980-81. Since the African countries which got their AIDS epidemic relatively recently has had about the same rapid onset as Sweden, the same must be valid for them. The conclusion could be made:- An underreporting of 90% just makes the time of the start of the epidemic to be reduced by 1-1,5 years.
If the recent pattern of the African countries which already in 1986 had got a growing epidemic with 100 or more cases are to be considered retrospectively, they subsequently must follow the same pattern as Cameroun, Gabon, Nigeria, Thailand and Togo. That includes a very sudden and steep rise in the beginning. Thus the starting point must be less than six-seven years before the year they passed 1000 cases. E.g. for Kenya that passed 1000 around 1987-88 must have got its first case after 80/81.
This leads to the important conclusion, that the origin of the AIDS epidemic in the different African countries are fully consistent with what the National Health authorities had reported earlier. There is actually no need to further put in question, that the African part of the AIDS pandemic originated in Uganda in 1982, three years after the origin of the world epidemic, which started in New York, USA 1978/79.
The very widespread speculations that the AIDS epidemic has got its origin in Africa are, after this evaluation of the epidemiological similar patterns, lacking any scientific support.
To find the origin of HIV and AIDS the very first patients must be searched for and by using this evaluation method they are traced to USA and New York where the first 14 appeared in 1979 with even one retrospectively diagnosed in December 1978. The first patients were even confined to Manhattan in Greenwich village and when their adresses were plotted onto a map, the New York City Blood Center was found in the epi-center. The Blood center was the place where an experimental vaccine was tested, using voluntary homosexual men as guinea-pigs, with its start in the autumn of 1978. According to the only published scientific report from this connection in JAMA in 1986 (Volume 255:pages 2167-72), it was also confirmed that the participants in the trial were noticed having HIV positive tests as early as 1978/79. These must be the very first HIV cases clearly connected with the epidemic. It has already been discussed that it seems less probable that the virus could have been present unnoticed for a longer time, but still there have been some reports in the scientific press of early cases, which have resembled AIDS. One of these reports have been about a man from Manchester in Great Britain, who obviously had an immune depression and died in 1959. His stored blood samples were HIV positive, and also by the PCR technique a genomic sequence could be detected. The sequence which was detected was very similar with the corresponding sequence in HIV. The authors of the publication concluded that the patient had an HIV infection (Corbitt et.al. Lancet 1990:336:51). But there is one thing missing in the report. The authors say they used the gag-- part of the causative virus to compare with HIV. But to control if HIV really was involved a species specific part of the genome must be choosen. In the case of HIV it has got unique sequences in the env part of the genome and to a lesser extent in the pol part whereas the gag part is similar for a great number of viruses, and actually they shouldn´t conclude anything more than that the patient probably had suffered from a viral disease.
Also the much quoted seropositive blood-test from Zaire 1959 (Nahmias et. al. Lancet 1986:i:1279-80) can´t be considered as evidence for HIV infection. In one out of 818 blood samples collected in 1959 they found one sample that reacted positive to an HIV test. But this just reflects the normal rate of false positive tests. When further the person who was the donator of the blood was unknown there was also no clinical picture to compare. For old cases the burden of proof must be increased, otherwise these ¨old¨ reports are just reduced to anecdotal stories.
But there is another interesting reflection among these old findings. When there is a possible African connection they are widely spread as evidence. When similar reports e.g. about Venezuelan indians showing seropositivity in 9 samples out of 224 and the samples were collected 1968-69 (Volsky et. al. N Engl J M 1986:314:647-48) the report was of less interest . Also concerning the Manchester case above his connection with Great Britain was of lesser interest, than his profession as a sailor and the speculation he had visitited African harbours.
There has, since 1985, when Gallo-Essex started to promote their speculations about an African origin of HIV and AIDS, been signs of a new widespread epidemic of repeating these speculations among the cohort of scientists, researchers and medical people carrying white skin and confined to western institutions. But there has been very few substantial facts to support their speculations. By this study their speculations without evidence must be considered as a phenomenon close to an epidemic syndrome, with many stages, where the last full blown stage is rasism as used by Hitler-Mengele against the Jews, as used by the Boers in South-African apartheid, as the yankees towards the native Indians and later towards the black Afro-American population, as the British in their Imperial wars. The underlying causative agent may be defined as the education brought to them from early chidhood, that their own culture is superior to that of other people. The AIDS epidemic has again shown that the professionals close to the medical establishment are very easily infected by this classifying of people, due to their selfappointed superiority. That this infection must not develop into the last full blown stage, science must again look into scientific facts and stop speculating.
The following reported cumulative figures were used for making the graphs.
Botswana: First report 1986. 13 cases (13.6 .87), 49 ( 31.3.89), 87 ( 17.1.90), 216 (31.7.91), 353 (3.6.92) ,439 (22.12.92), 1151 (30.8.93).
Brazil: First report 1982. 1695 (1986), 2010 (15.9.87), 2956 (apr 88), 9550 (30.12.89), 14500 (29.9.90), 21000 . ( 31.8.91), 31000 (10.12.92), 43000 (2.10.93)
Burundi: First 1984. 128 (31.3.87), 1156 (apr 1988), 2360 (30.6.90), 3300 (31.8.90), 6000 (20.3.92), 7200 . ( 10.12. 93)
Cameroun: First 1986. 25 (5.3.87), 62 (31.8.88), 78 (31.3.89), 243 (6.12.90), 429 (30.4.91), 1407 (5.10.92) , . . . . 2174 (31.12.92), 2870 (10.12.93)
Central African Republic: First 1984. 254 (31.10.86), 660 (31.12.88), 1800 (30.6.90), 3730 (30.11.92).
Congo: First 1983. 250 (13.11.86), 1250 (9.12.87), 2400 (31.12.90), 3482 (31.12.91), 5267 (30.12.92).
Cote d´Ivoire: First 1986. 118 (13.11.86), 1010 (23.10.89), 5400 (15.7.90), 8300 (13.6.91), 10800 (10.3.92). . . 14650 (5.7.93)
Ethiopia: First 1987. 5 (30.6.87), 81 (26.12.88), 285 (5.1.90), 636 (18.12.90), 1500 (31.10.91), 3980 (11.11.92), 8400 (30.9.93)
France: First 1981. 11 (-80), 19 (-81), 44 (-82), 127 (-83), 332 (-84), 835 (-85), 1922 (-86), 3980 (-87), 6600 (-88), 8900 (-89), 13000 (-90), 16500 (30.9.91), 21500 (17.12.92), 27000 (30.9.93).
Gabon: First 1987. 13 ( 6.7.87), 31 (1.6.89), 117 (31.12.90), 215 (31.12.91), 392 (1.3.93), 472 (10.12.93).
Ghana: First 1986. 145 (25.5.87), 1080 (31.10.89), 1700 (31.7.90), 2500 (30.6.91), 3600 (1.12.92), 11000 (30.4.93).
Kenya: First 1983. 286 (-86), 625 (30.7.87), 6000 (30.6.89), 9000 (31.5.90), 31200 (1.10.92), 38200 (9.7.93).
Malawi: First 1986. 13 (13.11.86), 2588 (30.6.88), 12000 (31.10.90), 22300 (2.12.92), 29200 (20.8.93).
Mozambique: First 1986. 1 (30.6.87), 9 (Mar 88), 40 (5.6.89), 162 (31.12.90), 288 (31.10.91), 538 (10.10.92), 826 (27.7.93).
Nigeria: First 1987. 5 (22.5.87), 35 (2.8.89), 48 (15.3.90), 84 (29.1.91), 184 (12.3.92), 552 (31.12.92), 722 (2.6.93)
Rwanda: First1983. 705 (30.11.86),1800 (31.8.89), 3400 (30.6.90), 5100 (31.3.91), 8500 (12.11.92), 10100 (10.12.93)
Sweden: First 1982. 1 (-82), 7 (-83), 18 (-84), 48 (-85), 102 (-86), 180 (-87), 265 (-88), 380 (-89), 510 (-90), 645 (-91), 800 (-92), 904 (30.9.93) , 943 (-93).
Tanzania: First 1984. 1000 (-86), 1130 (11.4. 87), 5600 (31.12.89), 7100 (27.7.90), 27400 (31.8.91), 34600 (31.5.92), 38700 (7.1.93)
Thailand: First 1984. 6 (-86), 11 (30.6.87), 32 (30.11.89), 69 (30.11.90), 119 (31.8.91), 909 (30.11.92), 3001 (30.11.93)
Togo: First 1987. 2 (dec 87), 15 (-88), 56 (-89), 100 (1.6.90), 1278 (31.12.91), 1953 (2.3.93), 2381 (10.12.93)
Uganda: First 1982. 1138 (28.2.87), 7400 (15.4.89), 21700 (31.12.90), 34600 (1.11.92)
USA: First 1978/79. 14 (-79), 80 (-80), 360 (-81), 1410 (-82), 5600 (-83), 11900 (-84), 23200 (-85), 43500 (-87), 95000 . ( 31.5.89), 149 000 (30.9.90), 202 000 (30.11.91), 242 000 (10.12.92), 339 000 (30.9.93)
Zaire: First1983. 335 (30.6.87), 4600 (31.12.88), 14800 (31.12.90), 18200 (14.5.92), 21000 (10.6.93)
Zambia: First 1986. 250 (-86), 395 (30.6.87), 1900 (31.3.89), 4700 (31.5.91), 6600 (15.10.92), 29700 (20.10.93)
Zimbabwe: First1983. 57 (-86), 380 (28.8.87), 499 (31.3.89), 5200 (30.9.90), 7400 (30.6.91), 12500 (31.3.92) 25300 (30.9.93).
Africa, the full continent , more than 50 states: First report 1982. 3 (-82), 17 (-83), 99 (-84), 305 (-85), 2750 (-86), 8700 (-87), 30 000 (-88), 65 000 (-89), 93 000 (-90), 152 000 (-91), 247 000 (-92), 301 000 (jun -93).