Jim Chin is one of the few brave people who will say in public that
overestimates and linking HIV to irrelevant other issues is often about
the money. If Piot is calling Jim Chin a denialist, and he appears to
be doing so, he is barking up the wrong tree. We have enough real
denialists around to risk devaluing this term.
Anyone think we need a population based survey in Burma / Myanmar?
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UNAIDS CRIES WOLF ABOUT AIDS
The UN agency coordinating global action against AIDS is wiping egg off its face after
reluctantly admitting it had overestimated India’s AIDS problem by more than half--
following numerous similar exaggerations world-wide.
In 2005 the Joint United Nation’s Program on AIDS (UNAIDS) claimed there were 5.7
million infected with HIV in India, giving India the highest number in the world, but the
Indian National AIDS Control Organization (NACO)figures for 2006 released on Friday
lowered the number to 2.5 million--and UNAIDS has had to admit the new estimate is
more accurate.
Director Peter Piot, speaking to an AIDS conference in South Africa in June said
UNAIDS’s work “...is further complicated by the mixed messages circulating around the
world” and “denialist statements such as that UNAIDS overestimates the size of the
epidemic….” The HIV overestimates made or accepted by UNAIDS in recent years total
about 10 million --so who is the real denialist?
Since 2001, UNAIDS has been forced to acknowledge drastically reduced HIV
prevalence estimates in over a dozen African, Caribbean and Asian countries, as a
result of well-designed “population-based” HIV surveys (randomly selected samples of
urban and rural populations) Kenya’s HIV estimate was reduced from about 2.3 million to
1.1 million in 2003. Ethiopia’s estimate was reduced from nearly two million to about a
half million in 2005. Haiti’s estimate of almost 250,000 HIV-infected adults in 2001 was
cut to less than 100,000 in 2006.
However, UNAIDS continued to defend its exaggerations up through 2006, as I pointed
out earlier this year in my book -The AIDS Pandemic: the collision of epidemiology
with political correctness*. UNAIDS were quick to respond to my charges, with spin
rather than substance, referring vaguely to their “scientific approach” to calculating HIV
numbers and the fact they collaborate with experts and governments. They refused to
acknowledge that their approach was wrong or that the figures were bogus until the
Indian revision exposed both. UNAIDS has simply glossed over the new estimates as
being the result of better data and improved methods that are constantly evolving.
Some AIDS activists say there is no harm in overestimating the current size and
potential severity of the AIDS pandemic since such exaggerations have successfully
provided AIDS programs with unprecedented global priority and support. It needs to be
recognized that UNAIDS was established in 1995 as an advocacy and coordinating
agency that almost immediately turned over responsibility for AIDS program funding and
technical guidance to other international agencies and donors. However, UNAIDS did
not turn over responsibility for the estimation and projection of HIV/AIDS numbers. Since
UNAIDS has declared itself to be primarily an advocacy agency, its objectivity in making
or accepting high HIV estimates and projections needs to be questioned.
UNAIDS, AIDS program advocates and activists have certainly used inflated HIV
numbers effectively in their aggressive struggle for an increasing share of the limited
international health budget. This success, however, has come at the expense of other
equally urgent public health needs.
Regardless of UNAIDS’s systematic overestimation of HIV numbers, the severity of the
AIDS pandemic in sub-Saharan Africa requires that AIDS programs in this region
continue to receive the highest public health priority. In India too, whether HIV
prevalence is close to six million or “only” 2.5 million, AIDS remains a serious public
health problem in this populous country.
A UNAIDS spokesperson has said that the new calculation for India reduces the world
estimate to about 37.5 million people and that UNAIDS does not expect any more
revisions from countries with major HIV and AIDS epidemics: “India was the last
unknown.”
As of 2007, there are about 50 countries where HIV prevalence has been estimated to
be more than one percent of the adult population. More than half of these countries have
had their HIV prevalence estimate based on the flawed method that relied on “sentinel
surveillance sampling” of mostly urban antenatal clinics: this was extrapolated to the
total national adult population, although towns have the highest HIV prevalence. So how
can UNAIDS be so confident that there will not be any more revisions from countries
with major HIV epidemics?
Inflating HIV numbers, whether unintentionally due to honest misunderstanding or
intentionally by deliberate exaggeration, may work in the short term. In the long term, it
will cause a backlash and the withdrawal of public and policymaker support when such
inflated numbers and false alarms cannot be defended.
If UNAIDS persists with ignoring inflated HIV estimates, it risks losing credibility and the
support of the rich governments that fund the global fight against AIDS.
Whatever the purpose crying wolf is neither good science nor good politics.
James Chin, MD, MPH
Clinical Professor of Epidemiology, School of Public Health, University of California at
Berkeley
Formerly, Chief of the Surveillance, Forecasting and Impact Assessment unit, Global
Programme on AIDS (GPA) of the World Health Organization (WHO), Geneva,
Switzerland
Sheraton-Taipei, July 10, 2007
