Regions

• Africa
• Asia
• Europe
• North America
• South America

Categories

• Environment
• Health
• Technology
• Trade & Development

Similar Articles

Similar Posts

UNAids, beware of crying wolf

THE UN agency coordinating global action against Aids is wiping egg off its face after reluctantly admitting it had overestimated India's problem of acquired immune deficiency syndrome (Aids) by more than half - following numerous similar exaggerations worldwide.

In 2005 the Joint United Nations Programme on HIV/Aids (UNAids) claimed there were 5.7 million people infected with HIV in India - the highest number in the world. But the Indian National Aids Control Organisation (Naco) figures for last year, released yesterday, lowered the number to 2.5 million - and UNAids has had to admit the new estimate is more accurate.

UNAids director Peter Piot, speaking at an Aids conference in South Africa last month, said the agency'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 more than 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 2.3 million to 1.1 million in 2003. Ethiopia's estimate was reduced from nearly two million to about half a million in 2005. And Haiti's estimate of almost 250,000 HIV-infected adults in 2001 was cut to fewer than 100,000 last year.

However, UNAids continued to defend its exaggerations up through last year, as I pointed out earlier this year in my book The Aids Pandemic: The Collision Of Epidemiology With Political Correctness.

UNAids was quick to respond to my charges, with spin rather than substance, referring vaguely to its 'scientific approach' to calculating HIV numbers and the fact that it collaborates with experts and governments. It refused to acknowledge that its 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 pandemic since such exaggerations have successfully provided Aids programmes with unprecedented global priority and support.

It needs to be recognised that UNAids was established in 1995 as an advocacy and coordinating agency that almost immediately turned over responsibility for Aids programme 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 programme 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' systematic overestimation of HIV numbers, the severity of the Aids pandemic in sub-Saharan Africa requires that Aids programmes 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 spokesman 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 this year, there are about 50 countries where HIV prevalence has been estimated to be more than 1 per cent 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?

Exaggerating the numbers, whether unintentionally due to honest misunderstanding, or intentionally, may work in the short term. In the long term, it will cause a backlash and damage support from the public and policymakers.

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.

Professor James Chin, a former chief of the surveillance, forecasting, and impact assessment unit of the WHO's Global Program on AIDS, is clinical professor of epidemiology at the School of Public Health, University of California at Berkeley.

Republishing This Article

We encourage republication of this article. No prior consent is required for such republication on condition that: the article is published in full, without alteration, with the author's name, including any first-publication credit given at the end of the article. If no first-publication credit is given, we encourage acknowledgement of CriticalOpinion.org as the source. If the article is republished on a website, please link to this page.

Disclaimer: Views expressed in the article are the author’s and are not necessarily shared by CriticalOpinion.org or International Policy Network.