Now the estimates are more accurate and Piot rants have been turned down a notch. We have all learned some lessons.
[him] moderator
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New Report to Show U.N. Overestimated AIDS Epidemic
Craig Timberg
Washington Post Foreign Service
Monday, November 19, 2007; 5:53 PM
JOHANNESBURG,
Nov. 19 -- The United Nation's top AIDS scientists this week plan to
acknowledge that they long have overestimated both the size and course
of the epidemic, which they now believe has been ebbing for nearly a
decade, according to U.N. documents prepared for the announcement.
AIDS
remains a devastating public health crisis in the most heavily impacted
areas of sub-Saharan Africa. But the sweeping revisions amount to at
least a partial acknowledgment of criticisms long leveled by outside
researchers who disputed the U.N.'s portrayal of an ever-rising
epidemic on the march across the globe.
The latest estimates,
due to be released publicly on 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, with the numbers of new infections
falling.
Having millions of fewer people with a lethal,
contagious disease is good news. However some researchers have
contended that persistent overestimates in the U.N.'s widely quoted
reports long have skewed funding decisions while also obscuring
potential lessons about how to slow the spread of HIV. Critics also
have said that U.N. officials overstated 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 bookThe 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 their report will not be
released publicly until Wednesday. In documents obtained by The
Washington Post, U.N. officials say the revisions came mainly from
better measurements rather than fundamental shifts in the epidemic
itself. They also say that they are seeking to continually improve
their tracking of AIDS with the latest available tools.
Among
the reasons for the overestimate is methodology; U.N. officials
traditionally based their HIV estimates for nations on the infection
rates among pregnant women receiving prenatal care. As a group, they
were more urban, wealthier, and likely to be more sexually active than
populations as a whole.
The U.N.'s 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, up to $10 billion a year.
But in its role in tracking the
spread of epidemic and recommending strategies to combat it, UNAIDS has
drawn criticism in recent years from Epstein and others who accused it
of being politicized and not scientifically rigorous.
For years,
UNAIDS reports have portrayed a sprawling, rising epidemic that
threatened to burst beyond its epicenter in southern Africa to create
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 these 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
U.N.'s tools for measuring and predicting 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. One of the most recent was India, where the U.N. cut its
estimate of HIV cases by more than half because of one such study
completed this year. The new report also has made major cuts to U.N.
estimates in Nigeria, Mozambique and Zimbabwe.
The revision
affected not just the current number 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 for that, this week's report says,
was 30 million.
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 long critical of UNAIDS, said 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,
California.
The picture of the AIDS epidemic portrayed by these
new studies, and set to be endorsed by U.N. scientists in this week's
announcement, show a massive concentration of infection in the southern
third of Africa, with nations such as Swaziland and Botswana reporting
that 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 --
combined with regional variations in sexual behavior are the biggest
factors in determining the severity of the epidemic in different
countries and even within countries.
Beyond Africa, the AIDS
epidemic 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.
http://www.washingtonpost.com
My first reaction to this was that this is devastating, a betrayal. How, why, overestimate by the millions instead of using the truth as evidence that efforts are working and then to push for increased efforts.