Mail & Guardian (Johannesburg) - June 25, 1999

Here, the government was so timid and inept for nearly a decade about explaining the full scope of the Aids threat that debates often veered off into peripheral issues - Virodene, Sarafina, faulty condoms. Sadly, Department of Health doctors with first-hand knowledge of the threat often feel muzzled, having to seek permission from Pretoria to speak about their own fields of expertise, so vigorous Aids-denial buffs were beginning to dominate the debate, which is the reason I piped up.

There are many schools of Aids denial. The "HIV-dissidents" one, which uses noseWeek as its publicist here, argues that Aids isn't caused by a virus but by a lifestyle.

As characterised in last week's Mail & Guardian, a "kamikaze-style approach to drugs and sex" made white San Francisco homosexuals exceptionally vulnerable to disease. Africans became similarly susceptible because of "continuous and repeated exposure to dire tropical diseases, such as malaria, without recourse to health care, together with various other factors that place the body under severe stress such as malnutrition and prolonged anxiety, both results of civil war and social disruption''.

The theory relies on absurdities. There was never a time, in San Francisco or anywhere else, in which all homosexuals were disco queens who snorted mountains of coke and boffed everyone within reach. Men who were faithful, boring gay stay-at-home spouses died of Aids. Publicly heterosexual men who had wives and children and a few furtive gay encounters died of Aids. Men who never had gay sex at all died of Aids after getting it from blood transfusions.

The African variant is even sillier. It presumes that all Africans live in mud huts, starving, swatting malarial mosquitoes and drinking from pools laced with hippo crap and bilharzia snails. It ignores the tens of thousands of Africans who live in Soweto - or Gaborone, Harare or Lusaka - drink piped water, get enough to eat, have no more malaria risk than the Oppenheimers do in Brenthurst, and yet are dying of Aids.

Until recently, Barclay's Bank in Zambia was seeing 2% of its workforce die each year, which is about 10 times the mortality rate for an American bank. The dying employees, 85% of whom died of Aids-related illnesses, the bank said, were overwhelmingly African white-collar workers with matric or university degrees. Their health care, through the Minbank Clinic, was First World level. They weren't "stressed". They were infected.

A well-known 1987 study of HIV infection at pre-natal clinics in Rwanda (at the time, seven years before the 1994 genocide, a tiny, well-organised country with excellent record- keeping) showed a pregnant woman had a 9% chance of infection if her husband was a farmer, a 22% chance if he was a soldier, a 32% chance if he was a white-collar worker and a 38% chance if he was a government official. (I decline to speculate on the implications of this for the Thabo Mbeki Cabinet.) The study's conclusion was that, in a very poor country like Rwanda, a regular paycheck meant more access to extramarital sex, raising the husband's chances of infection.

In South Africa, miners and other migrant labourers may have even higher risks, but the point is that the subsistence farmer in the mud hut is not the most at-risk guy, and the "poverty lifestyle causes Aids" argument is ridiculous. By the way, a doctor who specialises in treating Aids and tuberculosis cases in rural KwaZulu-Natal pointed out to me this week that there is another "medical" debate going on here that echoes the Aids one. Fortunately, the consequences are far less serious - just a lifetime of root canal work.

The health department is planning to add fluoride to South Africa's drinking water. The "fluoride-is-poison" lobby opposes it.

I remember this debate from my teenage years in the United States. At the same time as Crest, the first fluoride toothpaste, was getting recognition from the American Dental Association, cities were trying to add fluoride to their drinking water. Many studies had shown that it strengthened children's teeth. (Water is better than toothpaste. Since the fluorine atom actually joins the tooth structure, it is best to have it there - in tiny amounts all day long - as the tooth grows.)

Interestingly, in the US, the anti-fluoride lobby was led by the John Birch Society and other right wingers. Their argument, as far as I could tell, was that if the US government, which they believed was secretly controlled by communists, was allowed to add one chemical to the water, then it would soon be adding LSD and other drugs to control all our minds.

I can't say whether they were right on that score - you'll have to be the judge as to whether I'm out of my mind. I can tell you that, despite a lifetime of brushing and flossing, I have rotten teeth - straight, relatively white, but riddled with cavities and cracks. And so do many of my friends my age (45). Our children, on the other hand, have absolutely fabulous teeth. The difference, says every dentist I've had, and I've had plenty, is that they grew up drinking fluoridated water. (When we moved here, I made my kids take fluoride tablets.) Pediatric dentistry is now a struggling profession in the US. And good riddance - mine didn't believe in novocaine.

Besides, the John Birch Society was kidding itself - depending on where you live, chemicals are already added to your drinking water: alum to precipitate solids; chlorine to kill germs. And a good thing too - you know what those swimmers in the Vaal Dam are doing under water.

To my knowledge, while there have been plenty of brief bacterial outbreaks in drinking water in some US cities, no one has ever gotten fluoride poisoning from city water.

There are some benefits to being cut off from the world for 20 years. Learn from our mistakes.
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