Jim Chin thinks that the risk of generalised epidemics in Asia was exaggerated. That is true. The [him] moderator has heard many people in UNAIDS and in other organisations talk about the coming 'explosion'. Google 'explosion hiv asia unaids' to see for yourself. Replace the word 'asia' with the name of the country you are interested in.
Epstein doesn't know Asia at all.
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Books Accuse UNAIDS of Inflating HIV Prevalence Estimates To Increase Donor Funding
UNAIDS in two recently published books has "come under stinging attack" and been accused of "allowing politics to trump science in its efforts to combat" HIV/AIDS, AFP/Yahoo! News reports. According to AFP/Yahoo! News, the books have "sparked a wide-ranging debate" among HIV/AIDS advocates about how to fight the spread of the disease and "raised questions about UNAIDS' leadership."
U.S. epidemiologist James Chin in his book, "The AIDS Pandemic," accused UNAIDS of inflating HIV prevalence estimates to "dramatize the epidemic" and increase donor funding. Chin "appeared vindicated" earlier this year, when India reduced its HIV/AIDS caseload estimate to 2 million to 3.1 million people, AFP/Yahoo! News reports. UNAIDS previously estimated that the country had about 5.7 million people living with HIV/AIDS. In addition, the organization estimated that 1.6% of adults in Cambodia were HIV-positive, but the estimate later was reduced to 0.6% of adults, AFP/Yahoo! News reports.
Prasada Rao, UNAIDS regional director for Asia, said that the higher estimates were based on data from clinics, which experts used to estimate the number of people in the general population living with the virus. Rao added that the lower estimates were based on improved, random surveys among households, which provided a better analysis of the general population. "I don't see any motive on the part of UNAIDS to inflate numbers," Rao said, adding that he does not "think there is any axe to grind in this case."
Most experts agree that HIV/AIDS caseload estimates "remain a guess best used to show trends in each country," according to AFP/Yahoo! News. "There is a fine line between deliberately lying with the numbers or using the upper range of estimates that are based on slim assumptions and unrepresentative data," Chin said in an e-mail to Agence France Press. Both Chin and Rao agreed that the debate should focus more on how to spend resources than on the number of people living with HIV/AIDS.
In another recently published book, "The Invisible Cure," Helen Epstein, who studied HIV/AIDS in Africa, wrote that UNAIDS either misunderstood or ignored data in the mid-1990s that showed the practice of having multiple, long-term sexual partners was common in Eastern and Southern Africa and allowed HIV to spread quickly through the region. According to Epstein, rather than encouraging people to be faithful to one partner, UNAIDS focused on condom use and abstinence, which she says was less effective but more politically appealing.
Epstein added that the organization "overblew the prospects" for an HIV epidemic in Asia, where the virus is spread mainly through high-risk groups, whereas in Africa it is spread among the general population. "They got it almost perfectly wrong in some places," she said. Epstein added that UNAIDS previously focused more on potential HIV/AIDS outbreaks in other parts of the world rather than on addressing the disease in the most affected African countries.
Rao said he is concerned that if advocates believe UNAIDS is manipulating data, the agency's reputation and efforts to eradicate the disease could be damaged. "UNAIDS is not saying the data is wrong. It is accepting the data and trying to harmonize the facts," Rao said, adding, "That shows the openness that the organization has got on this issue. And it is prepared to correct its data (and) revise its data based on other sources of information" (Shea, AFP/Yahoo! News, 8/29).
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UNAIDS under fire for mixing politics and science
Date: Wednesday, August 29, 2007
Source: Agence France-Presse
BANGKOK (AFP) - UNAIDS, the global standard-bearer in the fight against HIV, has come under stinging attack in two new books accusing it of allowing politics to trump science in its efforts to combat the disease.
The most burning criticism, levied by American epidemiologist James Chin in his book "The AIDS Pandemic," accuses UNAIDS of intentionally inflating its estimates of how many people have HIV in order to dramatise the epidemic and win more money from donors.
Chin appeared vindicated in June, when India dramatically reduced its estimate of people infected to a range of 2.0-3.1 million from 5.7 million.
The earlier estimate had given India the tragic distinction of having more cases of HIV than any country in the world, including South Africa -- even though the virus affects a far greater percentage of South Africans.
International health experts have for years worried about the possibility of an AIDS epidemic in India on the scale of South Africa' s, but the new figures suggested a fairly low infection rate of 0.36 percent of the adult population.
The infection rate was earlier presumed to be 0.9 percent.
An equally sharp reduction was made in Cambodia, where the estimated infection rate was cut to 0.6 percent of adults from 1.6 percent.
UNAIDS regional director for Asia Prasada Rao told AFP the decreases were only about improved science and said the dramatic reduction in the estimates showed the agency's willingness to embrace new data.
"Ascribing motives to UNAIDS, that you are deliberately inflating the numbers to get more resources, that's really not something which I believe is acceptable," Rao said.
In both India and Cambodia, Rao said the reduced estimates were made because of improved surveys.
Earlier estimates were made based on data from clinics around each country, which experts used to guess how many people in the entire population have HIV.
The new data came from random surveys of households, which provides a broader picture, he said.
"I don't see any motive on the part of UNAIDS to inflate numbers. I don't think there is any axe to grind in this case," Rao said.
Whichever method is used to make the estimates, scientists agree the numbers remain a guess best used to show trends in each country.
But Chin said he believes UNAIDS had intentionally used the upper end of all its estimates to try to make the epidemic seem as devastating as possible.
"There is a fine line between deliberately lying with the numbers or using the upper range of estimates that are based on slim assumptions and unrepresentative data," he told AFP in an email.
Both men say the debate isn't really about numbers but about deciding how to spend often scant public health resources.
Helen Epstein, who has spent years studying AIDS in Africa, argues that the UN agency has missed the mark on that point as well.
In her book "The Invisible Cure" she says UN AIDS either misunderstood or ignored data in the mid-1990s that showed many people in eastern and southern Africa had multiple long-term sexual partners, creating a web of relationships that allowed HIV to spread quickly.
"Vast numbers of people were caught up in a network of sexual relationships that they didn't realise were so risky," she said.
Instead of trying to encourage people to stop having more than one partner, as Uganda successfully did with a "Zero Grazing" campaign in the 1980s, Epstein says AIDS activists focused on condoms and abstinence which proved less effective but were politically more appealing to liberals and conservatives.
The patterns of the diseas
e in Africa are different to those in Asia, for example, where it spreads mainly through high-risk groups like prostitutes, intravenous drug users, and men who have sex with men, she said.
"The thing that bothered me is the way that they overblew the prospects for an Asian epidemic," she said . "They got it almost perfectly wrong in some places. They pushed for a targeting of the general population in places like India, when they probably should have targeted high risk groups."
But in Africa, the high number of people infected "includes absolutely everybody -- teachers, doctors, farmers, market traders, politicians, everyone".
Epstein said UNAIDS has tended to cite the prospect of the disease exploding in other parts of the world, without focusing enough on African nations that have long been the hardest-hit.
The books have sparked a wide-ranging debate among activists about how to fight the disease and raised questions about UNAIDS leadership.
Rao insists the agency is open to criticism and has been adapting as new data becomes available.
He worries that if UNAIDS is seen to be manipulating information, that could damage the agency's reputation and ultimately efforts to stop the disease.
"UNAIDS is not saying the data is wrong. It is acce pting the data and trying to harmonise the facts," he said.
"That shows the openness that the organisation has got on this issue. And it is prepared to correct its data (and) revise its data based on other sources of information."
