Science Guardian

UN cuts 7 million from global total, new infections down 40%

A second retreat from overestimates forced by critics

But when will the other shoe drop - and the entire viral story be abandoned? Not soon

Well, well. Finally the UN is going to admit this week just how badly it overestimated the statistics for African AIDS, and that the supposed pandemic has been slowing for a decade.

The latest estimates, due to be released publicly Wednesday, put the number of annual new HIV infections at 2.5 million, a cut of more than 40 percent from last year’s estimate, documents show. The worldwide total of people infected with HIV — estimated a year ago at nearly 40 million and rising — now will be reported as 33 million.

The news report, U.N. to Cut Estimate Of AIDS Epidemic:Population With Virus Overstated by Millions, is from Craig Timberg in tomorrow morning’s Washington Post, where the admirable reporter already identified the problem nearly two years ago in April 2006 in his story How AIDS in Africa Was Overstated: Reliance on Data From Urban Prenatal Clinics Skewed Early Projections.

He writes that critics exerted pressure which partly brought about this official retreat, which is suitably embarrassing to the UN and will no doubt soon be surrounded by rationalizing explanations in line with the imaginary competence of UN statisticians, described by Rian Malan in Rolling Stone in 2001 as sitting in the UNAIDS offices in Geneva inflating the stats for the whole of Africa based on a few natal clinic reports which didn’t even include males.

Who were they, these estimators? For the most part, they worked in Geneva for WHO or UNAIDS, using a computer simulator called Epimodel. Every year, all over Africa, blood would be taken from a small sample of pregnant women and screened for signs of HIV infection. The results would be programmed into Epimodel, which transmuted them into estimates. If so many women were infected, it followed that a similar proportion of their husbands and lovers must be infected, too. These numbers would be extrapolated out into the general population, enabling the computer modellers to arrive at seemingly precise tallies of the doomed, the dying and the orphans left behind.

Because Africa is disorganised and, in some parts, unknowable, we had little choice other than to accept these projections. (‘We’ always expect the worst of Africa anyway.) Reporting on Aids in Africa became a quest for anecdotes to support Geneva’s estimates, and the estimates grew ever more terrible: 9.6 million cumulative Aids deaths by 1997, rising to 17 million three years later.

This latest development is a stunning story given the inevitable effect on international AIDS funding that it threatens, ie to divert billions into much more sensible areas such as malaria, TB, and especially in Africa, malnutrition, which is the major wrecker of immune systems, which are very easily crippled by undernourishment.

The United Nations’ AIDS agency, known as UNAIDS and led by Belgian scientist Peter Piot since its founding in 1995, has been a major advocate for increasing spending to combat the epidemic. Over the past decade, global spending on AIDS has grown by a factor of 30, reaching as much as $10 billion a year.

No doubt the counter propaganda is already being worked on day and night in the offices of WHO and UNAIDS and in Washington where director Anthony Fauci is undoubtedly telling his pr staff at NIAID to burn the midnight oil and come up with an Op Ed piece for the New York Times by Wednesday, when the report is officially out for all the “denialists” to crow about.

With $15 billion from Congress allocated for the fight against the HIV=AIDS meme, and a share of billions more from Gates, the likelihood of a climbdown from the paradigm itself seems as high as the chances of a macaque leaping over Weill-Cornell Medical Center in a single bound.

Still, we added a comment to prod readers thoughts, at least, in this direction:

Comment added by scienceguardian 12.15 am Tuesday:

So what forced them to acknowledge this poor performance, which was covered in the Post in
February, and well before that in Rian Malan’s piece in Rolling Stone six years ago, denied by everybody at the time, of course?

And when will the other shoe drop? That the entire description of the world wide HIV=AIDS pandemic as caused by an infectious virus is null and void, a relabeling of other assaults on the immune system, disease and - especially in Africa - malnutrition, in terms of a scientific paradigm that was bankrupt when it was announced, and has proved to be so ever since, but as righteously defended against “denialists” as the African statistics have long been.

No vaccine, no cure, no healthy medication, no mechanism, no predictive power - the theory that HIV causes AIDS, ridiculed by the knowledgeable in the field when it was announced by Bob “I discovered HIV in the mail from Paris” Gallo 23 years ago, is the shame of science and the shame of reporters both knowing and gullible who have failed to tell the public how little science there is to support it. Kudos to Craig and his editors for running against the herd and doing a little investigation for a change.

But when will the Post break ranks and join Harpers magazine (April 2006) in exposing this entire disgrace for what it is - a corruption of far greater social consequence than the UN statisticians’ incompetence?

Then the $15 billion authorized for African disease, and the billions allocated by Gates, can be devoted to malaria, TB, the health infrastructure, food and other real problems in Africa, and not diverted into harmful and misapplied drugs irrelevant to the real needs of the continent.

U.N. to Cut Estimate Of AIDS Epidemic

U.N. to Cut Estimate Of AIDS Epidemic
Population With Virus Overstated by Millions

By Craig Timberg
Washington Post Foreign Service
Tuesday, November 20, 2007; A01

JOHANNESBURG, Nov. 19 — The United Nations’ top AIDS scientists plan to acknowledge this week that they have long overestimated both the size and the course of the epidemic, which they now believe has been slowing for nearly a decade, according to U.N. documents prepared for the announcement.

AIDS remains a devastating public health crisis in the most heavily affected areas of sub-Saharan Africa. But the far-reaching revisions amount to at least a partial acknowledgment of criticisms long leveled by outside researchers who disputed the U.N. portrayal of an ever-expanding global epidemic.

The latest estimates, due to be released publicly Wednesday, put the number of annual new HIV infections at 2.5 million, a cut of more than 40 percent from last year’s estimate, documents show. The worldwide total of people infected with HIV — estimated a year ago at nearly 40 million and rising — now will be reported as 33 million.

Having millions fewer people with a lethal contagious disease is good news. Some researchers, however, contend that persistent overestimates in the widely quoted U.N. reports have long skewed funding decisions and obscured potential lessons about how to slow the spread of HIV. Critics have also said that U.N. officials overstated the extent of the epidemic to help gather political and financial support for combating AIDS.

“There was a tendency toward alarmism, and that fit perhaps a certain fundraising agenda,” said Helen Epstein, author of “The Invisible Cure: Africa, the West, and the Fight Against AIDS.” “I hope these new numbers will help refocus the response in a more pragmatic way.”

Annemarie Hou, spokeswoman for the U.N. AIDS agency, speaking from Geneva, declined to comment on the grounds that the report will not be released publicly until Wednesday. In documents obtained by The Washington Post, U.N. officials say the revisions stemmed mainly from better measurements rather than fundamental shifts in the epidemic. They also say they are continually seeking to improve their tracking of AIDS with the latest available tools.

Among the reasons for the overestimate is methodology; U.N. officials traditionally based their national HIV estimates on infection rates among pregnant women receiving prenatal care. As a group, such women were younger, more urban, wealthier and likely to be more sexually active than populations as a whole, according to recent studies.

The United Nations’ AIDS agency, known as UNAIDS and led by Belgian scientist Peter Piot since its founding in 1995, has been a major advocate for increasing spending to combat the epidemic. Over the past decade, global spending on AIDS has grown by a factor of 30, reaching as much as $10 billion a year.

But in its role in tracking the spread of the epidemic and recommending strategies to combat it, UNAIDS has drawn criticism in recent years from Epstein and others who have accused it of being politicized and not scientifically rigorous.

For years, UNAIDS reports have portrayed an epidemic that threatened to burst beyond its epicenter in southern Africa to generate widespread illness and death in other countries. In China alone, one report warned, there would be 10 million infections — up from 1 million in 2002 — by the end of the decade.

Piot often wrote personal prefaces to those reports warning of the dangers of inaction, saying in 2006 that “the pandemic and its toll are outstripping the worst predictions.”

But by then, several years’ worth of newer, more accurate studies already offered substantial evidence that the agency’s tools for measuring and predicting the course of the epidemic were flawed.

Newer studies commissioned by governments and relying on random, census-style sampling techniques found consistently lower infection rates in dozens of countries. For example, the United Nations has cut its estimate of HIV cases in India by more than half because of a study completed this year. This week’s report also includes major cuts to U.N. estimates for Nigeria, Mozambique and Zimbabwe.

The revisions affect not just current numbers but past ones as well. A UNAIDS report from December 2002, for example, put the total number of HIV cases at 42 million. The real number at that time was 30 million, the new report says.

The downward revisions also affect estimated numbers of orphans, AIDS deaths and patients in need of costly antiretroviral drugs — all major factors in setting funding levels for the world’s response to the epidemic.

James Chin, a former World Health Organization AIDS expert who has long been critical of UNAIDS, said that even these revisions may not go far enough. He estimated the number of cases worldwide at 25 million.

“If they’re coming out with 33 million, they’re getting closer. It’s a little high, but it’s not outrageous anymore,” Chin, author of “The AIDS Pandemic: The Collision of Epidemiology With Political Correctness,” said from Berkeley, Calif.

The picture of the AIDS epidemic portrayed by the newer studies, and set to be endorsed by U.N. scientists Wednesday, shows a massive concentration of infections in the southern third of Africa, with nations such as Swaziland and Botswana reporting as many as one in four adults infected with HIV.

Rates are lower in East Africa and much lower in West Africa. Researchers say that the prevalence of circumcision, which slows the spread of HIV, and regional variations in sexual behavior are the biggest factors determining the severity of the AIDS epidemic in different countries and even within countries.

Beyond Africa, AIDS is more likely to be concentrated among high-risk groups, such as users of injectable drugs, sex workers and gay men. More precise measurements of infection rates should allow for better targeting of prevention measures, researchers say.

Comments on the piece so far (12.15am Tuesday November 19 2007) UPDATE November 22 4.19 pm a good insider one added this Thanksgiving morning, first quote:

screenwalker wrote:
Let’s look at the topic in general here to potentially provide a cui bono:

The M&E (monitoring and evaluation) issues with AIDS are in general not substantial different from other pandemics etc.
Given this and as it is possible to establish proper figures with e.g. pneumonia and all other epidemics or diseases where no large amounts of “funding” are involved or particular political targets are pursuit there must be other reasons.

Two examples (anecdotal):

1. When SARS first hit, China was even trying to adjust their population numbers to make them look smaller and downplay the issues (ask people at the WHO that were involved at that time)

2. How are figures collected / processed that later are reported regarding AIDS:

First (again anecdotal) the WHO a few years ago did an IT / IS fair for all areas they work in. Guess what - anywhere but with AIDS, Malaria and TB processes and supporting applications could be identified and were showcased. But particular with AIDS it became clear that “data collections” were on an individual “researcher” base captured and edited by individuals within this and other organizations in MS Excel spreadsheets only. Anybody who knows how to use MS Excel also might knows how “easily” numbers on collections that scale “might be lost” or “mistakingly” overwritten/edited. It’s just not the right tool for such an endeavor. The situation since then might have changed with some of the organizations involved.

Second, one of the organizations that receive the majority of fundings from the G8 for the “fight against AIDS” (billions of USD - dozens of times what UNAIDS receives) still - even internally - treats all detail data received from countries as “top secret” and makes it available even internally only after “massaging” the numbers. There is the story that about 2 years ago they were ordered to collect data in a systematic way. It took two weeks - with the support of some IT tools - to get the picture. After that about a hundred people “massaged” the numbers for more than 3 months until the numbers were in line with what was already reported before. They also have a “track record” of being a “computer free zone” to the extend that people that tried to bring in accountability have been fired and those that have (openly) sabotaged this got promoted or “palmed off”. Read - we do anything to block accountability or systematic approaches. The IT solutions that allowed the data collections earlier were almost immediately turned off. Instead piles of documents / paper are produced to cover up. If you look at the overall relationship here Government G8 (should follow accountability rules) - kind of NGO / Internationally coordinated organization (impression of accountability only) - Developing Country (accountability , well you decide up to 80% corruption in some) you might understand what this is all about.

If the money would arrive with those in need nothing would be wrong with that but unfortunately - as some of the most reputable people in the “trade” report - it does not.

Given all of this I believe pointing at people like P.Piot does not cut to the core of the issue. There is no single person - particular not the head of UNAIDS , responsible for that. The WHO and UNAIDS today only represent a minority share in the “money streams” within AIDS. Look at USAIDS, PEPFAR, DFID, TGF, UNDP…

P.S. There is a story going around in Geneva that one of the key players involved in the “fight against AIDS” blows more money in 2 months on “administrative tasks” than the WHO or UNAIDS have as a budget for 2 years.
The worst of all - this might be in line with a change of thinking that was last popular in the 1950s. Within this dreadful context the name Thomas Malthus returns to mind…
11/22/2007 12:10:33 AM

Previously cynical1 wrote:
As a former WHO employee, I can reinforce the thrust of the article that statistics are manipulated in an effort to obtain higher budgets. Many of the regional offices of WHO can not repeat not intelligently spend their budgets and create “Agreed Program of Work” to absorb the excess funds as the budget period comes to a close. The latest accounting/enterprise system which was approved with certain cost efficiencies as a requirement have not reulted in one position to be eliminated. The contrary is in fact the truth. WHO needs an immediate overhaul and the US Government should start looking harder at its participation in these agencies rather than blindly endorse corrupt practices and equally corrupt officials.

Your Comments On…
U.N. to Cut Estimate Of AIDS Epidemic
JOHANNESBURG, Nov. 19 — The United Nations’ top AIDS scientists plan to acknowledge this week that they have long overestimated both the size and the course of the epidemic, which they now believe has been slowing for nearly a decade, according to U.N. documents prepared for the announcement.
-
By Craig Timberg

Comments
msmithnv wrote:
This is very good news.

I think the controversial at first plain talking public education campaign launched in Africa is starting to work.

The theme, “The Rear is not a Gear.” seemed too bold at first but evidently broke through the consciousness of over exposed safe sex messages about condoms and spoke to the heart of the matter.

11/19/2007 11:38:44 PM
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ooyah32 wrote:
“Researchers say that the prevalence of circumcision, which slows the spread of HIV, and regional variations in sexual behavior are the biggest factors determining the severity of the AIDS epidemic in different countries and even within countries.”

What? WHAT??? Circumcision and sexual behavior are the biggest factors in limiting HIV/AIDS? How can this be? The elites have told us for years that only condoms are the answer, that condoms are the number one factor in limiting HIV/AIDS.
11/19/2007 11:34:51 PM
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ooyah32 wrote:
I am shocked — SHOCKED — that scientists would allow politics to color and dictate their scientific findings.
11/19/2007 11:30:14 PM
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krushX wrote:
Since when have prostitutes and hustlers, pimps and stars of pornographic movies been legitimized as “sex workers”? Isn’t the Post going a little far here in trying to sanitize the sleazy underbelly of society? The very term sounds stupid. Usually we use the term “laborers” rather than workers, as in field laborers and day laborer, so I guess this is sex labor?

Besides, high-risk groups for AIDS vary based on culture. In India it was India it was truck drivers who frequented prostitutes — or as the Post would have it sex workers.
11/19/2007 11:14:57 PM
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sales3 wrote:
For AIDS, $10bn globally, total = 1 month in Iraq

You guys are so pathetically callous and cheap, you squeak.
11/19/2007 9:45:37 PM
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erkola wrote:
To overstate numbers for political and financial support, by the U.N. no less, is hitting near the bottom. When you begin to undermine peoples’ charitable nature, a complete turning away from helping any charity, regardless of how desperate, is possible. Then what?
11/19/2007 8:41:55 PM
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shady02 wrote:
No surprise here. The UN is joke. They are doing the same thing now with all their global warming reports.
11/19/2007 8:04:21 PM
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cynical1 wrote:
As a former WHO employee, I can reinforce the thrust of the article that statistics are manipulated in an effort to obtain higher budgets. Many of the regional offices of WHO can not repeat not intelligently spend their budgets and create “Agreed Program of Work” to absorb the excess funds as the budget period comes to a close. The latest accounting/enterprise system which was approved with certain cost efficiencies as a requirement have not reulted in one position to be eliminated. The contrary is in fact the truth. WHO needs an immediate overhaul and the US Government should start looking harder at its participation in these agencies rather than blindly endorse corrupt practices and equally corrupt officials.
11/19/2007 8:00:20 PM
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bobmoses wrote:
“There was a tendency toward alarmism, and that fit perhaps a certain fundraising agenda.”

Sound like the UN’s position on global warming.
11/19/2007 7:34:50 PM
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amengeo wrote:
The UN misquoting of AIDS figures adds another few nails in the coffin of credibility of these public institutions which assail us with a constant barrage of alarmist ‘findings’ and ‘reports.’ The next time I read that the ‘international community [read the US, Western Europe, Canada and Australia’] believes the sky is going to fall, or that ‘millions will die in Darfur or that we need to ‘rush rice to starving children in Kenya and your $10 will help,’ I going out to get the shovel. Is it any wonder that with these credibility gaps from governments, agencies, religious figures and Presidents that most people distrust those in authority? Weapons of Mass deception, anyone?
11/19/2007 7:24:13 PM
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12thgenamerican wrote:
just slide global warming in where it says aids and you will have a future headline.
11/19/2007 6:52:38 PM
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gitarre wrote:
“There was a tendency toward alarmism, and that fit perhaps a certain fundraising agenda.”

What a genteel turn of phrase. Save that quote for the similar article, coming within a year or two, on “Global Warming” …
.
11/19/2007 6:35:28 PM

The massive death toll from AIDS in Africa has not materialized. There is no country today that has a population smaller than it was 5 years or 10 years or 20 years ago. In fact, what is not pointed out in the article, is that for instance the population of Uganda doubled between 1980 and 2000, from 12 million to 24 million. In 2005, it stood at 28 million. So why do we put any stock in predictions made for Southern Africa, when the figures and predictions for West, East and Central Africa were completely off base? Source: US Census Bureau,

We added a comment

Comment added by scienceguardian 12.15 am Tuesday:

So what forced them to acknowledge this poor performance, which was covered in the Post in
February, and well before that in Rian Malan’s piece in Rolling Stone six years ago, denied by everybody at the time, of course?

And when will the other shoe drop? That the entire description of the world wide HIV=AIDS pandemic as caused by an infectious virus is null and void, a relabeling of other assaults on the immune system, disease and - especially in Africa - malnutrition, in terms of a scientific paradigm that was bankrupt when it was announced, and has proved to be so ever since, but as righteously defended against “denialists” as the African statistics have long been.

No vaccine, no cure, no healthy medication, no mechanism, no predictive power - the theory that HIV causes AIDS, ridiculed by the knowledgeable in the field when it was announced by Bob “I discovered HIV in the mail from Paris” Gallo 23 years ago, is the shame of science and the shame of reporters both knowing and gullible who have failed to tell the public how little science there is to support it. Kudos to Craig and his editors for running against the herd and doing a little investigation for a change.

But when will the Post break ranks and join Harpers magazine (April 2006) in exposing this entire disgrace for what it is - a corruption of far greater social consequence than the UN statisticians’ incompetence?

Then the $15 billion authorized for African disease, and the billions allocated by Gates, can be devoted to malaria, TB, the health infrastructure, food and other real problems in Africa, and not diverted into harmful and misapplied drugs irrelevant to the real needs of the continent.

Here is the earlier story in the Washington Post by Craig Timberg April 6 2006, Previous story on HIV exaggerated estimates in Africa in Washington Post: How AIDS in Africa Was Overstated: Reliance on Data From Urban Prenatal Clinics Skewed Early Projections:

Rwanda, a mountainous country of about 8.5 million people jammed into a land area smaller than Maryland, has relied on approaches similar to those used in Uganda, and may have produced similar declines in HIV. UNAIDS estimated in 1998 that 370,000 Rwandans were infected, equal to 12.75 percent of all working-age adults and a substantial percentage of children as well. Every two years since, the agency has lowered that estimate — to 11.2 percent in 2000, 8.9 percent in 2002 and 5.1 percent in 2004.

Dirk van Hove, the top UNAIDS official in Rwanda, said the next official estimate, due in May, would show an infection rate of “about 3 percent,” in line with the new national study. He said the U.N. estimate tracked the declining prevalence.

Rwandan health officials say their national HIV infection rate might once have topped 3 percent and then declined. But it’s just as likely, they say, that these apparent trends reflected nothing more than flawed studies.

Correction to This Article
An April 6 article and an accompanying graphic said the HIV rate among people in Botswana ages 15 to 49 was 34.9 percent. More recent information shows the rate to be 25.3 percent. The faulty statistic from the article was also used in an April 10 editorial.
How AIDS in Africa Was Overstated
Reliance on Data From Urban Prenatal Clinics Skewed Early Projections

By Craig Timberg
Washington Post Foreign Service
Thursday, April 6, 2006; A01

KIGALI, Rwanda — Researchers said nearly two decades ago that this tiny country was part of an AIDS Belt stretching across the midsection of Africa, a place so infected with a new, incurable disease that, in the hardest-hit places, one in three working-age adults were already doomed to die of it.

But AIDS deaths on the predicted scale never arrived here, government health officials say. A new national study illustrates why: The rate of HIV infection among Rwandans ages 15 to 49 is 3 percent, according to the study, enough to qualify as a major health problem but not nearly the national catastrophe once predicted.

The new data suggest the rate never reached the 30 percent estimated by some early researchers, nor the nearly 13 percent given by the United Nations in 1998.

The study and similar ones in 15 other countries have shed new light on the disease across Africa. Relying on the latest measurement tools, they portray an epidemic that is more female and more urban than previously believed, one that has begun to ebb in much of East Africa and has failed to take off as predicted in most of West Africa.

Yet the disease is devastating southern Africa, according to the data. It is in that region alone — in countries including South Africa, Botswana, Swaziland and Zimbabwe — that an AIDS Belt exists, the researchers say.

“What we know now more than ever is southern Africa is the absolute epicenter,” said David Wilson, a senior AIDS analyst for the World Bank, speaking from Washington.

In the West African country of Ghana, for example, the overall infection rate for people ages 15 to 49 is 2.2 percent. But in Botswana, the national infection rate among the same age group is 34.9 percent. And in the city of Francistown, 45 percent of men and 69 percent of women ages 30 to 34 are infected with HIV, the virus that causes AIDS.

Most of the studies were conducted by ORC Macro, a research corporation based in Calverton, Md., and were funded by the U.S. Agency for International Development, other international donors and various national governments in the countries where the studies took place.

Taken together, they raise questions about monitoring by the U.N. AIDS agency, which for years overestimated the extent of HIV/AIDS in East and West Africa and, by a smaller margin, in southern Africa, according to independent researchers and U.N. officials.

“What we had before, we cannot trust it,” said Agnes Binagwaho, a senior Rwandan health official.

Years of HIV overestimates, researchers say, flowed from the long-held assumption that the extent of infection among pregnant women who attended prenatal clinics provided a rough proxy for the rate among all working-age adults in a country. Working age was usually defined as 15 to 49. These rates also were among the only nationwide data available for many years, especially in Africa, where health tracking was generally rudimentary.

The new studies show, however, that these earlier estimates were skewed in favor of young, sexually active women in the urban areas that had prenatal clinics. Researchers now know that the HIV rate among these women tends to be higher than among the general population.

The new studies rely on random testing conducted across entire countries, rather than just among pregnant women, and they generally require two forms of blood testing to guard against the numerous false positive results that inflated early estimates of the disease. These studies also are far more effective at measuring the often dramatic variations in infection rates between rural and urban people and between men and women.

UNAIDS, the agency headed since its creation in 1995 by Peter Piot, a Belgian physician, produced its first global snapshot of the disease in 1998. Each year since, the United Nations has issued increasingly dire assessments: UNAIDS estimated that 36 million people around the world were infected in 2000, including 25 million in Africa. In 2002, the numbers were 42 million globally, with 29 million in Africa.

But by 2002, disparities were already emerging. A national study in the southern African country of Zambia, for example, found a rate of 15.6 percent, significantly lower than the U.N. rate of 21.5 percent. In Burundi, which borders Rwanda in central East Africa, a national study found a rate of 5.4 percent, not the 8.3 percent estimated by UNAIDS.

In West Africa, Sierra Leone, just then emerging from a devastating civil war, was found to have a national prevalence rate of less than 1 percent — compared with an estimated U.N. rate of 7 percent.

Such disparities, independent researchers say, skewed years of policy judgments and decisions on where to spend precious health-care dollars.

“From a research point of view, they’ve done a pathetic job,” said Paul Bennell, a British economist whose studies of the impact of AIDS on African school systems have shown mortality far below what UNAIDS had predicted. “They were not predisposed, let’s put it that way, to weigh the counterevidence. They were looking to generate big bucks.”

The United Nations started to revise its estimates in light of the new studies in its 2004 report, reducing the number of infections in Africa by 4.4 million, back to the total four years earlier of 25 million. It also gradually decreased the overall infection rate for working-age adults in sub-Saharan Africa, from 9 percent in a 2002 report to 7.2 percent in its latest report, released in November.

Peter Ghys, an epidemiologist who has worked for UNAIDS since 1999, acknowledged in an interview from his office in Geneva that HIV projections several years ago were too high because they relied on data from prenatal clinics.

But Ghys said the agency made the best estimates possible with the information available. As better data emerged, such as the new wave of national population studies, it has made revisions where necessary, he said.

“What has happened is we have come to realize that indeed we have overestimated the epidemic a bit,” he said.

On its Web site, UNAIDS describes itself as “the chief advocate for worldwide action against AIDS.” And many researchers say the United Nations’ reliance on rigorous science waned after it created the separate AIDS agency in 1995 — the first time the world body had taken this approach to tackle a single disease.

In the place of previous estimates provided by the World Health Organization, outside researchers say, the AIDS agency produced reports that increasingly were subject to political calculations, with the emphasis on raising awareness and money.

“It’s pure advocacy, really,” said Jim Chin, a former U.N. official who made some of the first global HIV prevalence estimates while working for WHO in the late 1980s and early 1990s. “Once you get a high number, it’s really hard once the data comes in to say, ‘Whoops! It’s not 100,000. It’s 60,000.’ ”

Chin, speaking from Stockton, Calif., added, “They keep cranking out numbers that, when I look at them, you can’t defend them.”

Ghys said he never sensed pressure to inflate HIV estimates. “I can’t imagine why UNAIDS or WHO would want to do that,” he said. “If we did that, it would just affect our credibility.”

Ghys added that studies now show that the overall percentage of Africans with HIV has stabilized, though U.N. models still show increasing numbers of people with the virus because of burgeoning populations.

Many other researchers, including Wilson from the World Bank and two epidemiologists from the U.S. Agency for International Development who wrote a study published last week in the Lancet, a British medical journal, dispute that conclusion, saying that the number of new cases in Africa peaked several years ago.

Some involved in the fight against AIDS say that tallying HIV cases is not nearly as important as finding the resources to fight the disease. That is especially true now that antiretroviral drugs are more affordable, making it possible to extend millions of lives if enough money and health-care workers are available to facilitate treatment.

“It doesn’t matter how long the line is if you never get to the end of it,” said Francois Venter, a South African doctor and head of Johannesburg General Hospital’s rapidly expanding antiretroviral drug program, speaking in an interview in Johannesburg.

But to the researchers who drive AIDS policy, differences in infection rates are not merely academic. They scour the world looking for evidence of interventions that have worked, such as the rigorous enforcement of condom use at brothels in Thailand and aggressive public campaigns that have urged Ugandans to limit their sexual partners to one.

Programs deemed successful are urged on other countries and funded lavishly by international donors, often to the exclusion of other programs.

Rwanda, a mountainous country of about 8.5 million people jammed into a land area smaller than Maryland, has relied on approaches similar to those used in Uganda, and may have produced similar declines in HIV. UNAIDS estimated in 1998 that 370,000 Rwandans were infected, equal to 12.75 percent of all working-age adults and a substantial percentage of children as well. Every two years since, the agency has lowered that estimate — to 11.2 percent in 2000, 8.9 percent in 2002 and 5.1 percent in 2004.

Dirk van Hove, the top UNAIDS official in Rwanda, said the next official estimate, due in May, would show an infection rate of “about 3 percent,” in line with the new national study. He said the U.N. estimate tracked the declining prevalence.

Rwandan health officials say their national HIV infection rate might once have topped 3 percent and then declined. But it’s just as likely, they say, that these apparent trends reflected nothing more than flawed studies.

Even so, Rwanda’s cities show signs of a serious AIDS problem not yet tamed. The new study found that 8.6 percent of urban, working-age women have HIV. Overall, officials say, 150,000 Rwandans are infected, less than half the number estimated by UNAIDS in 1998.

Bruno Ngirabatware, a physician who has treated AIDS patients in Kigali since the 1980s, said he has seen no evidence of a recent decline in HIV infection rates.

“There’s lots of patients there, always,” he said.

Here are the Comments posted on the earlier article, How AIDS in Africa Was Overstated:

This article is an excellent start to rewriting the history of AIDS in Africa and the horrific — and phony — statistics that have been used for too long to tell entire populations of Africans that they are doomed to die from AIDS and nothing except maybe billions of dollars worth of expensive, toxic antiviral drugs can save them. It doesnt go far enough, though. It doesnt mention that the terrifying estimates of HIV seroprevalence in South Africa were made by the same invalid technique — extrapolating from a handful of tests on pregnant women to an entire population — as the ones in Rwanda, Ghana, Sierra Leone and the other countries mentioned in the article. It also doesnt discuss the fact that pregnancy itself is known to cause false-positives on the standard HIV antibody tests — or that the more often a woman has been pregnant before, the more likely a new test is to be false-positive and women in Africa and other parts of the developing world tend to get pregnant more often than those in developed countries, partly because they have to in order to reproduce their populations in the face of high infant mortality and partly because of lack of access to birth control….

The massive death toll from AIDS in Africa has not materialized. There is no country today that has a population smaller than it was 5 years or 10 years or 20 years ago. In fact, what is not pointed out in the article, is that for instance the population of Uganda doubled between 1980 and 2000, from 12 million to 24 million. In 2005, it stood at 28 million. So why do we put any stock in predictions made for Southern Africa, when the figures and predictions for West, East and Central Africa were completely off base? Source: US Census Bureau….

Your Comments On…
How AIDS in Africa Was Overstated
KIGALI, Rwanda — Researchers said nearly two decades ago that this tiny country was part of an AIDS Belt stretching across the midsection of Africa, a place so infected with a new, incurable disease that, in the hardest-hit places, one in three working-age adults were already doomed to die of it.
- By Craig Timberg
Comments

If rich European nations and other better off countries would invest more in the stop of ait and modernization of the parts that are still so called uncivilized I think the aids spread rate would drop significantly.

By killerdan56 | Jul 19, 2006 3:22:33 PM | Request Removal

This article is an excellent start to rewriting the history of AIDS in Africa and the horrific — and phony — statistics that have been used for too long to tell entire populations of Africans that they are doomed to die from AIDS and nothing except maybe billions of dollars worth of expensive, toxic antiviral drugs can save them. It doesnt go far enough, though. It doesnt mention that the terrifying estimates of HIV seroprevalence in South Africa were made by the same invalid technique — extrapolating from a handful of tests on pregnant women to an entire population — as the ones in Rwanda, Ghana, Sierra Leone and the other countries mentioned in the article. It also doesnt discuss the fact that pregnancy itself is known to cause false-positives on the standard HIV antibody tests — or that the more often a woman has been pregnant before, the more likely a new test is to be false-positive and women in Africa and other parts of the developing world tend to get pregnant more often than those in developed countries, partly because they have to in order to reproduce their populations in the face of high infant mortality and partly because of lack of access to birth control.

By mgconlan | Aug 6, 2006 6:17:03 PM | Request Removal

The massive death toll from AIDS in Africa has not materialized. There is no country today that has a population smaller than it was 5 years or 10 years or 20 years ago. In fact, what is not pointed out in the article, is that for instance the population of Uganda doubled between 1980 and 2000, from 12 million to 24 million. In 2005, it stood at 28 million. So why do we put any stock in predictions made for Southern Africa, when the figures and predictions for West, East and Central Africa were completely off base? Source: US Census Bureau,

By avdeelen | Feb 24, 2007 9:14:39 AM | Request Removal

Here is the article by Rian Malan in Rolling Stone Magazine, November 22, 2001, AIDS in Africa: In Search of the Truth, by Rian Malan:

And that’s my story: enigma upon enigma, riddle leading to riddle, and no reprieve from doubt. Local actuarial models say 352,000 South Africans have died from AIDS since the epidemic began. The MRC says 517,000. The figure from a group I haven’t even mentioned yet, the United Nations Population Division, is double that - 1.06 million - and the unofficial WHO/UNAIDS projections are even higher. I have wasted a year of my time and thousands of Rolling Stone’s editorial-budget dollars, and all I can really tell you is that my faith in science has been dented. These guys can’t agree on anything.

Ordinary Africans everywhere see that the scourge is moving among them. The guide who showed me around Uganda had lost two siblings. Our driver had lost three. On the banks of the Kagera River, where the plague began, we met a sad old man who said all five of his children had died of it.

But ask these people about access to health care, and they laugh ruefully. “The coffee price is collapsing,” they say. No one has money. We can’t even afford transport to hospital, let alone medicine.” All across rural east Africa, doctors confirmed the charge: no money, no medicine. Even mission hospitals now ask patients for money.

“What can we do?” asks Father Boniface Kaayabula, who works at a Catholic mission in rural Uganda. “We have no money, too. We must ask people to pay, and only a very few can.”

So what do poor Africans do if they fall sick? They go to roadside shacks called “drug stores” and buy snake oil. Chloroquine for malaria, on a continent where that former miracle drug has lost most of its curative power; nameless black-market antibiotics for lung diseases, in a setting where up to sixty percent of pneumonia is drug-resistant; penicillin for gonorrhea, administered by an amateur “injectionist” who might be unaware that the quantity needed to knock out the infection has risen a hundredfold in the past decade. For the poorest of the poor, even such dubious nostrums are beyond reach. They try to cure themselves with herbs, they fail, and they die.

Rolling Stone Magazine, November 22, 2001

AIDS in Africa

In Search of the Truth

by Rian Malan

See graphics one and two for title illustration by Mark Ulriksen

Dear Jann,

You will be saddened to hear that Adelaide Ntsele has died. As you may recall, she featured briefly in my article a year ago about the long, twisted history of the song, “The Lion Sleeps Tonight,” which was based on a melody composed by her father, Solomon Linda. While I interviewed her sisters about the life and times of their father, the great Zulu singer, Adelaide was swooning feverishly under greasy blankets. She got up from her sickbed only to have her picture taken. She was so weak she could barely stand, but she wanted to be in your magazine.

I took her to hospital afterward. We sat in Emergency for a long time, waiting for attention. Her sister Elizabeth was there, too. She’s a nurse. She looked at Adelaide’s hospital card and grew very quiet. Later, she told me there was a symbol indicating that Adelaide had come up positive on an HIV test. Atop that she had tuberculosis and a gynecological condition that required surgery. The operation had already been postponed repeatedly. To Elizabeth, it looked like the the doctors had decided, “Well, this one’s had it, she’ll die anyway, just let it happen.” And so it did.

A year ago, the funeral scene would have written itself. I would have described the kindly old pastor, the sad African singing, the giant iron pots on fires for the ritual goodbye feast. I would have mentioned the eerie absence of any reference to AIDS in the eulogies and made some rote observation about the denial it betokened. I would have scanned the faces of mourners, trying to pick out the one in five who were carriers of the virus that put Adelaide in her coffin, withered and shriveled like a child. And in the end I would have turned sadly away, lamenting a society that allowed a thirty-seven-year-old woman to die because she couldn’t afford the drugs available to rich white people.

Instead, I spent the ceremony thinking about viral antigens, cross-reactions and other mysteries of what Sowetans call H.I.Vilakazi, the scourge of the deadly three letters. Then, midway through the proceedings, the pastor broke my reverie; Perhaps the visitors would like to say something? I rose to my feet, straightened my tie and prepared to speak my mind, but courage failed me, so I mumbled a few platitudes instead. “It is a heartbreak that Adelaide was taken so young,” I said. “She bore terrible suffering with enormous dignity,” I said. “We will always remember her as she appears in that picture,” I concluded, nodding toward a framed portrait of a wistful young woman with huge doe eyes and haunting cheekbones like Marlene Dietrich’s. Adelaide wanted to be a model. She never made it. I extended my condolences to the family and sat down again.

It wasn’t the eulogy Adelaide deserved, but then it wasn’t the right time or place for a great cry of rage and confusion, either. But now the mourning is done, and there are things that must be said.

photo of Adelaide Ntsele her friends at funeral

1.

MY FIRST MISTAKE

Africa’s era of megadeath dawned in the fall of 1983, when the chief of internal medicine of a hospital in what was then Zaire sent a communique to American health officials, informing them that a mysterious disease seemed to have broken out among his patients. At the time, the United States was being convulsed by its own weird health crisis. Large numbers of gay men were coming down with an unknown disease of extraordinary virulence, something never seen in the West before. Scientists called it GRID, an acronym for Gay-Related Immune Deficiency. Political conservatives and holy men called it God’s vengeance on sinners. American researchers were thus intrigued that a similar syndrome had been observed in heterosexuals in Africa. A posse of seasoned disease cowboys was convened and sent forth to investigate.

On October 18th, 1993, they walked into Kinshasa’s Mama Yemo Hospital, led by Peter Piot, 34, a Belgian microbiologist who had been to the institution years earlier, investigating the first outbreak of Ebola fever. A change was immediately apparent. “In 1976, there were hardly any young adults in orthopedic wards,” Piot told a reporter. “Suddenly - boom - I walked in and saw all these young men and women, emaciated, dying.” Tests confirmed his worst apprehensions: The mysterious new disease was present in Africa, and its victims were heterosexual. When researchers started looking for the newly identified human immunodeficiency virus, it turned up almost everywhere - in eighty percent of Nairobi prostitutes, thirty-two percent of Ugandan truck drivers, forty-five percent of hospitalized Rwandan children. Worse, it seemed to be spreading very rapidly. Epidemiologists plotted figures on graphs, drew lines linking the data points and gaped in horror. The epidemic curve peaked in the stratosphere. Scores of millions - maybe more - would die unless something was done.

These prophecies transformed the destiny of AIDS. In 1983, it was a fairly rare disease, confined largely to the gay and heroin-using subcultures of the West. A few years later, it was a threat to all of humanity itself. “We stand nakedly before a pandemic as mortal as any there has ever been,” World Health Organization chief Halfdan Mahler told a press conference in 1986. Western governments heeded his anguished appeal for action. Billions were invested in education and prevention campaigns. According to the Washington Post, impoverished AIDS researchers suddenly had budgets that outstripped their spending capacity. Nongovernmental AIDS organizations sprang up all across Africa - 570 of them in Zimbabwe, 300 in South Africa, 1,300 in Uganda. By 2000, global spending on AIDS had risen to many billions of dollars a year, and activists were urging the commitment of many billions more, largely to counter the apocalypse in Africa, where 22 million were said to carry the virus and 14 million to have died of it.

And this is about where I entered the picture - July 2000, three months after South African President Thabo Mbeki announced that he intended to convene a panel of scientists and professors to re-examine the relationship between the human immunodeficiency virus and AIDS. Mbeki never exactly said AIDS doesn’t exist, but his action begged the question, and the implications were mind-bending. South Africa was said to have more HIV infections (4.2 million) than any other country on the planet. One in five adults were already infected, and the toll was rising daily. As his words sank in, disbelief turned to derision.

“Ludicrous,” said the Washington Post.

“Off his rocker,” said the Spectator.

“A little open-mindedness is fine,” said Newsday. “But a person can be so open-minded, his brains can fall out.”

The whole world laughed, and I rubbed my hands with glee: South Africa was back on the world’s front pages for the first time since the fall of apartheid; fortune awaited the man of action. I went to see a friend who happens also to be an AIDS epidemiologist. He was so enraged by what he called the “genocidal stupidity” of Mbeki’s initiative that he’d left work and gone home, where I found him slumped in depression. “Hey,” I said, snap out of it. Let’s make a deal.” And so we did: He’d talk, I’d type, and together we’d tell the inside story of Thabo Mbeki’s AIDS fiasco. All that remained was to consider to consider the evidence that had led our leader astray.

According to newspaper reports, Mbeki had gleaned much of what he knew from the Web, so I revved up the laptop and followed him into the virtual underworld of AIDS heresy, where renegade scientists maintain Web sites dedicated to the notion that AIDS is a hoax, dreamed up by a diabolical alliance of pharmaceutical companies and “fascist” academics whose only interest is enriching themselves. I visited several such sites, noted what they had to say, and then turned to Web sites maintained by universities and governments, which offered crushing rebuttals. Can’t say I understood everything, because the science was deep and dense, but here’s the gist:

Look at AIDS from an African point of view. Imagine yourself in a mud hut, or maybe a tin shack on the outskirts of some sprawling city. There’s sewage in the streets, and refuse removal is nonexistent. Flies and mosquitoes abound, and your drinking water is probably contaminated with feces. You and your children are sickly, undernourished and stalked by diseases for which you’re unlikely to receive proper treatment. Worse yet, these diseases are mutating, becoming more virulent and drug-resistant. Minor scourge such as diarrhea and pneumonia respond sluggishly to antibiotics. Malaria now shrugs off treatment with chloroquine, which is often the only drug for it available to poor Africans. Some strains of tuberculosis - Africa’s other great killer - have become virtually incurable. Now atop all this is AIDS.

According to what you hear on the radio, AIDS is caused by a tiny virus that lurks unseen in the blood for many years, only to emerge in deep disguise: a disease whose symptoms are other diseases, like TB, for instance. Or pneumonia. Running stomach, say, or bloody diarrhea in babies. These diseases are not new, which is why some Africans have always been skeptical, maintaining that AIDS actually stands for “American Idea for Discouraging Sex.” Others say nonsense, the scientists are right, we’re all going to die unless we use condoms. But condoms cost money and you have none, so you just sigh and hope for the best.

Then one day you get a cough that won’t go away, and you start shedding weight at an alarming rate. You know these symptoms. In the past, you could take some pills and they would usually go away. But the medicines don’t work anymore. You get sicker and sicker. You wind up in the AIDS ward.

The orthodox scientists, if they could see you lying there, would say your immune system has been destroyed by HIV, allowing the tuberculosis (or whatever) to run riot. The dissidents would say no way - the virus is a harmless creature that just happens to accompany immune-system breakdown caused by other factors, in this case a lifetime of hunger and exposure to tropical pathogens.

Incensed by this, the orthodoxy whistles up a truckload of studies from all over Africa showing that HIV-positive hospital patients die at astronomical rates relative to their HIV-negative counterparts. The dissidents claim to be unimpressed. This proves nothing, they say except that dying hospital patients carry the virus.

The orthodoxy grits its teeth. There’s only one way to crush these rebels, and that’s to show that AIDS is a new disease that has caused a massive increase in African mortality, which is of course the truth as we know it: 22 million Africans infected, with 14 million more already dead from it.

These frightening numbers were all that mattered, it seemed to me. Once they were shown to be accurate, further debate would be rendered obscene, and Thabo Mbeki would be guilty as charged, a fool who’d allowed himself to be swayed by a tiny band of heretics universally dismissed as wackos, fringe lunatics and scientific psychopaths. So I set out to confirm the death toll. Just that. I thought it would be easy - a call or two, maybe a brief interview. I picked up the phone. It was my first mistake.

2.

A Forbidden Thought

There was a time when I imagined medical research as an idealized endeavor, carried out by scientists interested only in truth. Up close, it turns out to be much like any other human enterprise, riven with envy, ambition and the standard jockeying for position. Labs and universities depend on grants, and grantmaking is fickle, subject to the vagaries of politics and intellectual fashion, and prone to favor scientists whose work grips the popular imagination. Every disease has champions who gather the data and proclaim the threat it poses. The cancer fighters will tell you that their crisis is deepening, and more research money is urgently needed. Those doing battle with malaria make similar pronouncements, as do those working on TB, and so on, and so on. If all their claims are added together, you wind up with a theoretical global death toll that “exceeds the number of humans who die annually by two- to threefold,” said Christopher Murray, a World Health Organization director.

Malaria kills around 2 million humans a year, roughly the same number as AIDS, but malaria research currently gets only a fraction of the resources devoted to AIDS. Tuberculosis (1.7 million victims a year) is similarly sidelined, to the extent that there were no new TB drugs in development at all as of 1998. AIDS, on the other hand, is replete, employing an estimated 100,000 scientists, sociologists, caregivers, counselors, peer educators and stagers of condom jamborees. Until the attacks of September 11th diverted the world’s anxieties (and charity dollars), the level of funding for AIDS grew daily as foundations, governments and philanthropists such as Bill Gates entered the field, unnerved by the bad news, which usually arrived in the form of articles describing AIDS as a “merciless plague” of “biblical virulence,” causing “terrible depredation” (as Time recently put it) among the world’s poorest people.

These stories all originate in Africa, but the statistics that support them emanate from the suburbs of Geneva, where the World Health Organization has its headquarters. Technically employed by the United Nations, WHO officials are the world’s disease police, dedicated to eradicating illness. They crusade against old scourges, raise the alarm against new ones, fight epidemics, and dispense grants and expertise to poor countries. In conjunction with UNAIDS (the joint United Nations Programme on HIV/AIDS, based at the same Geneva campus), the WHO also collects and disseminates information about the AIDS pandemic.

In the West, the collection of such data is a fairly simple matter: Almost every new AIDS case is scientifically verified and reported to government health authorities, who inform the disease police in Geneva. But AIDS mostly occurs in Africa, where hospitals are thinly spread, understaffed and often bereft of the laboratory equipment necessary to confirm HIV infections. How do you track an epidemic under these conditions? In 1985, the WHO asked experts to hammer out a simple description of AIDS, something that would enable bush doctors to recognize the symptoms and start counting cases, but the outcome was a fiasco - partly because doctors struggled to diagnose the disease with the naked eye, but mostly because African governments were too disorganized to collect the numbers and send them in. Once it become clear that the case-reporting system wasn’t working, the WHO devised an alternative, by which Africa’s AIDS statistics are now primarily based.

It works like this: On any given morning anywhere in sub-Saharan Africa, you’ll find crowds of expectant mothers ling up outside government prenatal clinics, waiting for a routine checkup that includes the drawing of a blood samp