Sharp Differences Between Victims There and in the U.S. : Study Hopes to Uncover Why Zaire Leads Africa in AIDS Cases

In some parts of Africa, they call it “the horror sex disease” and suggest that it is a plot by the developed world to infect Africa with the worst maladies of modern civilization.

And some image-conscious Africans seem worried that Africa may be blamed as the source of the disease.

The disease in question is AIDS (acquired immune deficiency syndrome). Although no one is sure how the disease may have come to the African continent, there is no question that it is here and that it is just as deadly as in the West. AIDS has turned up in at least 10 countries in tropical Africa, and more cases of AIDS have been reported in Zaire than in any other African nation.

No figures are available on the number of AIDS cases here or the number of lives it has claimed. But preliminary studies in Africa do show a sharp difference in the distribution of victims: In the United States, 93% of AIDS victims are men, while in Africa the victims seem roughly evenly divided between males and females.

Study to Last 2 Years

No one here will speculate yet on the significance of these findings in Zaire, other than to note that this is the first study in which it has been demonstrated that AIDS may strike outside the relatively narrow confines of the groups that have been victims in the United States, principally homosexual males, intravenous drug users and people using human blood products.

Since last June, an epidemiologist from the Centers for Disease Control in Atlanta has been working in Kinshasa to study the disease in Zaire. Dr. Jonathan Mann, the Centers for Disease Control representative and the head of the project, has been joined by a representative from the National Institutes of Health, Dr. Henry Francis. The team soon will include a Belgian clinician from the Institute of Tropical Medicine in Antwerp. Their work is being conducted under the overall guidance of the Zairian Ministry of Public Health.

The study is scheduled to run for two years. Now, only six months into their work, Mann said the analytical part of the team’s work is still uncompleted.

“We do not yet have the laboratory data to effectively analyze the information we’ve collected,” Mann said in a recent interview. “We hope in a couple of months we will not only have the data, but have the data analyzed so we can present the analysis to the Zairian government.”

Information Issue

Under the agreement between the Centers for Disease Control and the Zairian government, only the Zairian Ministry of Public Health is authorized to discuss any results of the study. Those results are, in any case, preliminary, and the Zairians will not even go so far as to disclose the number of AIDS cases confirmed in the country.

“The information is sensitive,” a spokesman for the ministry said.

Some sources who should be in a position to know, however, say that about 300 cases have been officially diagnosed. Mann and his team, sticking fast to the government guidelines, will not say.

“It is a sensitive issue to the Zairians,” a Western diplomat said in Kinshasa. “They do not want to be identified as the source of AIDS. Also remember that much of the rest of the world remembers Zaire as a place of violence and chaos back in the ‘60s, when it was the Congo, and they don’t need any more negative associations with their country’s image.”

AIDS surfaced in the United States in 1981. The disease was also diagnosed in Europe the same year, and even more cases were reported in 1982. By 1983, it became obvious in Europe that there were two different groups of AIDS patients. One group was similar to American AIDS patients--homosexual males, intravenous drug users or persons associated with blood transfusions.

Lacked Usual Risk Factors

The other group, “much smaller but nevertheless identifiable . . . was made up of Africans from sub-Saharan Africa, some of whom had come to Europe specifically to seek care for a medical problem that was subsequently identified as AIDS,” Mann said.

“Interestingly, those people appeared to not have the risk factors that the other group had--that is, none of them appeared to be homosexuals, none appeared to be intravenous drug users. The transfusion issue was not looked into very closely, but the big risk factors did not appear to be present.”

Most of those cases turned up in Belgium, the former colonial power in Zaire, and in France, with a smaller number of cases in Britain. The greatest number of those AIDS patients had gone to Europe from Zaire.

With that background, an international team from the United States and Belgium arrived in Kinshasa for a preliminary survey in October, 1983. It found that AIDS existed in Zaire, that it affected men and women roughly equally and that some clinical details of the disease appeared to differ from American and European patterns.

More Intestinal Ills

In the United States, research by the Centers for Disease Control has shown, a lung disease and a rare form of skin cancer--Kaposi’s sarcoma--have been associated with AIDS in 83% of reported cases.

“In Zaire,” Mann said, “the preliminary survey showed that those problems appear to be much less common . . . and that other health problems were appearing.”

In general, Mann said, the AIDS victims in Zaire appear to have more intestinal problems. “The thing to remember is that the immune system is paralyzed and so the system is prey to whatever is in the environment,” he said.

Some AIDS patients here are afflicted with severe diarrhea and vomiting. Yeast infections in the gastrointestinal tract also may prevent absorption of nourishment. In the United States, medical literature has noted the presence of a parasitic infection, cryptospiroidiosis, in the intestinal tracts of AIDS victims.

Interestingly, Kaposi’s sarcoma has been recognized for years as a relatively common disease in Africa, where it is known to be particularly virulent. Until the disease began to appear in the United States associated with AIDS patients, most cases of Kaposi’s sarcoma in the United States were considered mild malignancies. Cases of Kaposi’s associated with AIDS in the United States have resembled the more deadly form of the disease known in Africa.

Development Traced

Mann said his team’s work has not focused on the possibility that AIDS may have been present in Africa before it turned up in the United States.

“Some people in the university here have looked into one of the infections that people can get with AIDS,” he said. “It’s a rare infection otherwise, a form of meningitis, cryptococcal meningitis. When they look back into the records, they find virtually no cases of that disease prior to the last couple of years. In the last couple of years, they have seen a rise.

“In other words,” he said, “using that as a kind of marker for AIDS--and it is far from being a perfect marker for AIDS--they found very few cases prior to a couple of years ago. But it has been increasing. There were more cases in 1984 than in 1983, for example. So that could suggest that AIDS is a new condition here. But beyond that, there is only speculation.

“One of the problems is that whenever you talk about a case that might have been AIDS 10 years ago, 20 years ago or even 5 years ago, since the laboratory testing was not available, unless the patient is still alive, which is usually not the case, you really don’t know. Once you get back beyond a couple of years, you are in the realm of speculation and hypothesis.”

Analytical Equipment

Mann’s team has assembled an array of sophisticated analytical equipment to help diagnose the disease. With Zairian technicians learning to operate computers and other equipment, the team has established its laboratory at Mama Yemo Hospital in Kinshasa, a sprawling complex of buildings situated in the heart of the city. As with most government-operated hospitals across the continent, its standards of hygiene, equipment and trained personnel are well below those of the developed world. Here, as elsewhere in Africa, a shortage of money is the main handicap.

Outside Mann’s scientific domain, there is no shortage of speculation and hypothesis. Some foreigners, for example, assume that AIDS is rampant in Zaire, but no one is able to provide any figures to back up the assertion.

Little Homosexuality

One thing that does seem clear is that there seems to be very little homosexuality in Zaire.

“I think there is no society in the world where one would say that there is zero homosexuality,” Mann said. “But it seems to be an uncommon, even rare, phenomenon in Zaire. Everyone seems to agree on that.”

Although Mann declined to elaborate, the study in Zaire is clearly focusing on the possibility of some kind of sexual transmission for the disease.

A source outside the study team said a significant proportion of the Zairian female victims are prostitutes. Mann, when queried on this point, would say only, “We have victims from all walks of life.”

In the United States, studies have indicated that, among male homosexual victims, those with a large number of sexual partners show a special vulnerability to the disease.

Mann said he thinks it unlikely that the team in Zaire will come up with any great breakthroughs toward a cure for AIDS.

“We are looking for an understanding of the way the disease works here,” he said. “I think there is a relatively slim chance that we would discover something about the virus or something about those sorts of issues that would not be discovered in the United States or Europe, where the research ability is massive and an incredible amount of effort is being put into the subject.

Different From U.S.

“What we have here is an area where the disease appears to be spreading in ways that are different than are currently occurring in the United States. What is exciting is that we have the sophisticated research tools and techniques to be able to study the disease in an environment where it is behaving differently.

“Why is AIDS spreading among both men and women in Zaire? When we can answer that question in a scientific manner, with careful investigation so we don’t get misled by red herrings--of which there are always some--then we will have armed ourselves,” Mann said.

“We will have learned something that can be incredibly important in terms of prevention--important here because the disease is already occurring this way and we may be able to prevent new cases, important for the rest of the world because, if indeed heterosexual contact becomes a major mode of transmission, which is a possibility, not at all a certainty, then what we learn here could be a big head start toward prevention elsewhere.”

In Zaire, there have been no official announcements that the American team is working in the country, although many people know it. At least in Zaire, there have been no newspaper articles blaming the West for infecting the nation.

‘Guinea Pigs’ Charge

In Kenya recently, on the other hand, a newspaper columnist charged that people from the developed world, who were infected with AIDS, were coming to Africa to infect Africans, thereby providing the world with a supply of “human guinea pigs with which to test various drugs or sell ineffective ones to.”

The study in Zaire, Mann said, is not concerned with the question of whether AIDS originated in Africa. To Mann, it makes no difference where the disease originated.

“It is not an objective of the project,” he said. “It is relatively unlikely that in any of the information we collect there would be any information that would genuinely or scientifically address that question. But it is also not what we are here for.”