Pandemic politics, Margaret Wente, 23/11/07
Post
For the past decade, United Nations scientist Peter Piot has been sounding the alarm about the growing scourge of AIDS. “The pandemic and its toll are outstripping the worst predictions,” he warned last year. “[It] is now one of the make-or-break forces of this century.” The Western world has responded, with AIDS funding that has swelled to $10-billion a year.
But this week brought some surprising news about the epidemic. It's shrinking. Annual new HIV infections have plunged by 40 per cent, to 2.5 million. And the total number of people infected with HIV has also fallen – down to 33 million from 40 million.
What happened? Are prevention programs finally working? Has someone found a cure?
Not exactly. What happened was that the UN's top AIDS scientists were finally forced to admit that their numbers had been wildly overstated. “They had clearly been using inflated numbers for some years,” charged Stephen Lewis, the former special UN envoy for HIV-AIDS in Africa. He even accused UNAIDS of being “irresponsible.”
Dr. James Chin of UC Berkeley has been tracking the disease since it first emerged. He is among the many epidemiologists who say the UN agency has cooked the numbers in order to get political and economic support. “I call them glorious lies and myths, because they're for a good cause,” he told me.
Both Mr. Lewis and Dr. Chin are quick to stress that AIDS is still a huge challenge and a monumental human tragedy. But the distortion of information has caused scarce public health resources to be wasted on programs aimed at people who simply aren't at risk. Meantime, the UN's relentless fear-mongering has spread abundant misconceptions about the disease. Here are a few of the more startling facts I learned from a conversation with Dr. Chin.
The AIDS epidemic is past its peak. Even UNAIDS has admitted that global HIV incidence had peaked by the late 1990s. This doesn't mean people will stop getting AIDS any time soon. But the infection rates are on the decline. The impact of prevention programs pales beside what's known as the saturation effect – meaning that people at the most risk have already been infected. Although prevention programs get the credit, one scientist has called this phenomenon “riding to glory on the down slope of the epidemic curve.”
AIDS is not a big problem outside Africa. (The continent still accounts for three-quarters of the world's AIDS deaths.) Despite widespread warnings that AIDS was about to explode across India, China and Southeast Asia, it hasn't. The UN has slashed its estimate of the HIV-infected population of India by almost two-thirds, back to 2.5 million. China has only a few hundred thousand infected people, not the millions that were predicted. Indonesia and the Philippines, where male circumcision is the norm, have escaped relatively unscathed, because circumcision is a major barrier to infection. The global infection rate outside of Africa is 0.2 per cent, says Dr. Chin. He thinks the UN numbers are still too high, and that the total number of infected might be as low as 22 million.
Outside Africa, people in the general population are unlikely to become infected. In the rest of the world, HIV is almost entirely confined to men who have sex with other men, intravenous drug users and female sex workers. That's an inconvenient truth for activists and fundraisers. “When you're trying to get the public and policy makers to take note, they're not going to be too keen on pouring money into men having sex with men and junkies and sex workers,” says Dr. Chin. He says a lot of effort and money have been wasted on programs directed at the general population.
The main driver of infection is not poverty, but high-risk sexual behaviour. In Africa, the richest countries have the highest infection rates, and richer people have much higher rates than poor ones. HIV hits hardest at Africa's teachers and professionals. In the West, where the biggest at-risk group is men who have sex with men, income isn't a factor either. “No matter how you look at it, poverty isn't driving it,” says Dr. Chin.
The riskiest behaviour is having multiple concurrent sexual partners. People with several overlapping sexual partners – a common practice in Africa – are at much higher risk. Westerners may have more sexual partners over a lifetime, but what matters is the pattern of behaviour. The single most effective way to reduce the spread of AIDS is partner reduction, or “mutual faithfulness.”
Even in sub-Saharan Africa, the news isn't all bad. The HIV infection rate has levelled off at about 3 per cent (Dr. Chin's estimate), which means that 97 per cent of the population is not infected. In Rwanda, for example, the infection rate is now thought to be 3 per cent, down from 14 per cent or even more. This is not to minimize the devastation: Africa has more than 11 million AIDS orphans, and in some countries, the death rates among the most educated and productive people are 20 or 30 per cent. In some places, the adult prevalence rate will be at least 5 to 10 per cent for decades to come. “On the ground, the situation in Africa is still appalling,” says Stephen Lewis.
AIDS is a terrible pandemic, but it's not the worst. Tuberculosis wiped out up to a billion people over the 18th and 19th centuries. Malaria kills a million people every year, mostly children under 5. Nor is AIDS a general killer. Unlike an influenza epidemic, which can infect up to half the population, it only hits selected subgroups.
And yet, a lot of people don't want to hear the (relatively) good news about AIDS. Dr. Chin and others who challenge the official line tend to be denounced for being callous and cold-hearted. After all, the global competition for dollars is fierce, and the stakes are huge. But Dr. Chin points out that in the end, fudging the facts doesn't help anyone – least of all the victims of this tragic, dreadful plague.
But this week brought some surprising news about the epidemic. It's shrinking. Annual new HIV infections have plunged by 40 per cent, to 2.5 million. And the total number of people infected with HIV has also fallen – down to 33 million from 40 million.
What happened? Are prevention programs finally working? Has someone found a cure?
Not exactly. What happened was that the UN's top AIDS scientists were finally forced to admit that their numbers had been wildly overstated. “They had clearly been using inflated numbers for some years,” charged Stephen Lewis, the former special UN envoy for HIV-AIDS in Africa. He even accused UNAIDS of being “irresponsible.”
Dr. James Chin of UC Berkeley has been tracking the disease since it first emerged. He is among the many epidemiologists who say the UN agency has cooked the numbers in order to get political and economic support. “I call them glorious lies and myths, because they're for a good cause,” he told me.
Both Mr. Lewis and Dr. Chin are quick to stress that AIDS is still a huge challenge and a monumental human tragedy. But the distortion of information has caused scarce public health resources to be wasted on programs aimed at people who simply aren't at risk. Meantime, the UN's relentless fear-mongering has spread abundant misconceptions about the disease. Here are a few of the more startling facts I learned from a conversation with Dr. Chin.
The AIDS epidemic is past its peak. Even UNAIDS has admitted that global HIV incidence had peaked by the late 1990s. This doesn't mean people will stop getting AIDS any time soon. But the infection rates are on the decline. The impact of prevention programs pales beside what's known as the saturation effect – meaning that people at the most risk have already been infected. Although prevention programs get the credit, one scientist has called this phenomenon “riding to glory on the down slope of the epidemic curve.”
AIDS is not a big problem outside Africa. (The continent still accounts for three-quarters of the world's AIDS deaths.) Despite widespread warnings that AIDS was about to explode across India, China and Southeast Asia, it hasn't. The UN has slashed its estimate of the HIV-infected population of India by almost two-thirds, back to 2.5 million. China has only a few hundred thousand infected people, not the millions that were predicted. Indonesia and the Philippines, where male circumcision is the norm, have escaped relatively unscathed, because circumcision is a major barrier to infection. The global infection rate outside of Africa is 0.2 per cent, says Dr. Chin. He thinks the UN numbers are still too high, and that the total number of infected might be as low as 22 million.
Outside Africa, people in the general population are unlikely to become infected. In the rest of the world, HIV is almost entirely confined to men who have sex with other men, intravenous drug users and female sex workers. That's an inconvenient truth for activists and fundraisers. “When you're trying to get the public and policy makers to take note, they're not going to be too keen on pouring money into men having sex with men and junkies and sex workers,” says Dr. Chin. He says a lot of effort and money have been wasted on programs directed at the general population.
The main driver of infection is not poverty, but high-risk sexual behaviour. In Africa, the richest countries have the highest infection rates, and richer people have much higher rates than poor ones. HIV hits hardest at Africa's teachers and professionals. In the West, where the biggest at-risk group is men who have sex with men, income isn't a factor either. “No matter how you look at it, poverty isn't driving it,” says Dr. Chin.
The riskiest behaviour is having multiple concurrent sexual partners. People with several overlapping sexual partners – a common practice in Africa – are at much higher risk. Westerners may have more sexual partners over a lifetime, but what matters is the pattern of behaviour. The single most effective way to reduce the spread of AIDS is partner reduction, or “mutual faithfulness.”
Even in sub-Saharan Africa, the news isn't all bad. The HIV infection rate has levelled off at about 3 per cent (Dr. Chin's estimate), which means that 97 per cent of the population is not infected. In Rwanda, for example, the infection rate is now thought to be 3 per cent, down from 14 per cent or even more. This is not to minimize the devastation: Africa has more than 11 million AIDS orphans, and in some countries, the death rates among the most educated and productive people are 20 or 30 per cent. In some places, the adult prevalence rate will be at least 5 to 10 per cent for decades to come. “On the ground, the situation in Africa is still appalling,” says Stephen Lewis.
AIDS is a terrible pandemic, but it's not the worst. Tuberculosis wiped out up to a billion people over the 18th and 19th centuries. Malaria kills a million people every year, mostly children under 5. Nor is AIDS a general killer. Unlike an influenza epidemic, which can infect up to half the population, it only hits selected subgroups.
And yet, a lot of people don't want to hear the (relatively) good news about AIDS. Dr. Chin and others who challenge the official line tend to be denounced for being callous and cold-hearted. After all, the global competition for dollars is fierce, and the stakes are huge. But Dr. Chin points out that in the end, fudging the facts doesn't help anyone – least of all the victims of this tragic, dreadful plague.
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