Pete Winn | Senior Staff Writer | Thursday, October 25, 2007
"This year, tell the truth on World AIDS Day," wrote former Ambassador Richard Holbrooke on Oct. 9 in the Washington Post. "Admit that we are still losing."
Holbrooke, president of the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria, said despite some progress, the epidemic continues to run unabated - especially in Africa, the continent hardest hit by AIDS.
But two epidemiologists - one at Harvard and the other at Berkeley - say this picture of AIDS isn't borne out by the statistics. Indeed, both say that while the epidemic is still serious, it is no longer raging out of control in most of the world, and the numbers reflect that fact.
Even in Africa, once portrayed as being a cemetery continent where an estimated one in every three adults would die from AIDS, the epidemic now appears to be turning a corner, especially in some parts of East Africa.
"The current numbers in Africa are around 20 to 22 million adults, out of a total population of 350 million adults, who are infected with HIV," said University of California public health professor Dr. James Chin. "If you include children in sub-Saharan Africa, we're talking about 25 million infections."
Admittedly, the numbers are still horrific - more than 2 million people in African states below the Sahara Desert have already died, creating millions of orphans. Almost two-thirds of all people living with HIV are in that region.
But even there, the numbers are not uniformly high.
"In South Africa, close to 20 percent of the adult population is infected with HIV, whereas in Ghana, it is only 2 to 3 percent of the population, and in Senegal, less than one percent is infected," Chin told Cybercast News Service.
Daniel Halperin, a senior research scientist at Harvard's Center on Population and Development, said of the 48 nations in sub-Saharan Africa, only a handful have extremely high adult prevalence rates of 15 percent or more.
"There are about 10 nations, all of them in Southern Africa, that have very bad epidemics," Halperin said. "Outside of those countries, for the most part, the rest of the world is not nearly as affected, although there are certain risk groups within some countries which have extremely high rates of HIV."
Halperin, the former HIV prevention adviser for the U.S. Agency on International Development (USAID), said infections have peaked in several African nations. In Uganda and Zambia the epidemic peaked around 1987, in Botswana and Lesotho around 1994, and in South Africa around 1997.
In Uganda, infection rates have actually fallen from 15 percent in the early '90s to around 6 percent currently.
"We're not trying to say there's no problem at all - there is, and in Southern Africa it is still huge," Halperin said. "But elsewhere, it's not quite as bad as it was being portrayed. And it's not necessarily getting worse, for the most part."
Granted, in a handful of nations - including Swaziland, South Africa and Botswana - the death rates are still going up.
"Keep in mind, though, that once the rate of infections starts going down, there is a lag of 10 years or more before the effects of AIDS - especially death rates - will start to improve," he added.
There is another reason why official infection rates are declining, the experts claim. Until recently, the world's centralized AIDS agency - the United Nations Joint Programme on HIV/AIDS, known as UNAIDS - has been providing the world inflated statistics.
Chin, who headed the World Health Organization's AIDS statistics office in Geneva, Switzerland during the '80s and '90s, said that for decades UNAIDS could only provide estimates on the epidemic - and "has been over-estimating it for years."
Since the introduction of highly accurate census-like population-based studies in the last five years, however, Chin said UNAIDS has been quietly forced to scale-back its estimates.
"Those studies, in a lot of African countries, have forced UNAIDS to revise downwards the estimates, often by two- or three-fold," Chin said. "The most recent example was Ethiopia, which had an estimate of 5 to 6 percent prevalence. When the population-based surveys were completed, the figure was reduced to about 1.5 percent."
According to Chin, UNAIDS has long relied on "sentinel" surveillance studies from African countries, in which researchers take HIV rates of pregnant women in urban areas and extrapolate those rates onto a whole country.
"Of the 22 population-based surveys completed to date, 20 of them have forced a reduction of about 50 percent or more in the estimates of the countries surveyed," he added.
As late as 2001, UNAIDS, backed by the WHO, had been saying that more than 9 percent of sub-Saharan Africans, aged 15 to 49, were infected. In that year, the percentage translated into 26 million. The more accurate figure is 6 percent.
Indeed, UNAIDS now officially gives what it calls "high" and "low" estimates. In one of the hardest hit African nations, Botswana, UNAIDS now says, for instance, that the low estimates of new cases among children (15+) went up from 5,100 cases to 6,100. The "high" estimates, however, say they increased from 31,000 to 32,000.
Independent AIDS researcher John Talbott, who is critical of both Chin and Halperin, told Cybercast News Service he thinks the international agency actually underestimates the extent of the disease but admits that U.N. statisticians have not only lowered their numbers in recent years, they have removed some of their previous estimates from public view.
"The U.N. won't share their historical data," Talbott said. "I think it's probably for this reason, that they don't want you to see the adjustments - it's not a smooth curve over history as to what their estimates are. I think they do have some jumps in the data. I've asked for years to see their historical data, but they won't share it with me."
Though Cybercast News Service was promised an interview with a UNAIDS/WHO expert on this topic, no interview was granted prior to press time.
But in a June 7 speech in South Africa, UNAIDS Executive Director Peter Piot denied that the U.N. inflates statistics and dismissed allegations such as those being made by scientists like Chin and Halperin as "AIDS denialism."
"The challenge is ... complicated by the mixed messages circulating around the world," Piot said. "Denialist statements such as that 'UNAIDS overestimates the size of the epidemic,' and 'There's too much money for AIDS' don't help, not least because there's clearly a massive gap between what's needed and what's available."
Both Chin and Halperin say they are not denialists - they are serious, internationally regarded scientists.
"I keep saying that if you cut the numbers in sub-Saharan Africa by half, it's still a significant problem. If you cut the numbers for India, you still have a significant problem," Chin added.
The author of a new book, "The AIDS Pandemic: The Collision of Epidemiology with Political Correctness," Chin said he doesn't think there are sinister motives behind the overblown stats. But political correctness plays a role.
He said AIDS activists have tended to accuse anyone wanting to reassess the epidemic or revise the statistics as trying to cut funding for AIDS.
"I think a lot of programs went out of their way to assure that they were not underestimating because of the activists," he said. "As a result they were overestimating."
Over the last five years, the U.S. has spent more than $15 billion to fight AIDS, with over $3 billion a year going to Africa.