Important note: Information in this article was accurate in 2007. The state of the art may have changed since the publication date.
Chicago Tribune - December 1, 2007
No, 6 million people weren't suddenly cured. UNAIDS had been making a bad count.
How could the UN have been so wrong? It relied on reports of infection rates gathered from pregnant women at health clinics. It used those numbers to extrapolate an AIDS rate for the general population. But that was a faulty way to calculate. And there's reason to suspect this hasn't been an entirely innocent error.
Dr. James Chin, an epidemiologist at the University of California, Berkeley, has argued for years that the UN overestimated the number of people infected with AIDS. From 1987 to 1992, Chin was in charge of making global and regional estimates of infection rates for the World Health Organization's global program on AIDS. That's when he began to monitor the rate of infection among pregnant women at clinics.
That research was intended to detect trends in HIV infection. It was never intended to be used for an estimate of the number of people with HIV/AIDS, Chin said. But that's how it was used. UNAIDS officials scoffed at Chin's charges that they kept the AIDS infection estimates artificially inflated to make a stronger case for AIDS funding. They say the new numbers are the result of better, door-to-door data collection. But you have to wonder if the competition for international assistance didn't have something to do with this mistake. In 2001, a senior policy official at UNAIDS estimated that the world needed to spend $7 billion to $10 billion annually to fight AIDS. Yet the total contributions to UNAIDS last year were less than $2 billion.
Yes, significant sums are needed to arrest the AIDS epidemic. But the more accurate counting suggests that AIDS funding can be better focused than it has been.
AIDS prevention efforts should be targeted to the most at-risk populations. "You don't have to get the message to the general public," Chin said. "The surveys will show that 70 to 80 percent of rural youth in Bangladesh don't know three ways to prevent HIV. But they don't have to know three ways to prevent HIV. They're not at any risk."
Then who is? Generally, IV drug users, sex workers and men who have sex with other men. The best way to avoid a spread of AIDS is to focus on reducing its prevalence in the at-risk groups. Yet there's still plenty of resistance in some countries to helping them avoid transmission of the disease.
The Bill & Melinda Gates Foundation recently pledged $50 million to target efforts at AIDS prevention in China. Sexual contact has overtaken intravenous drug use as the primary form of AIDS transmission there, according to Health Minister Chen Zhu. The epidemic, for now, remains largely confined there to prostitutes and gay men. One key problem: 60 percent of prostitutes don't regularly use condoms.
In sub-Saharan Africa, where HIV infects more than 20 percent of adults, officials need to persuade people to use condoms and have fewer sex partners.
Even Chin, the UN's most insightful critic, says that $2 billion a year won't curb the AIDS epidemic. "In Africa, if you cut the numbers in half it's still a catastrophe," Chin said. "The money needed for treatment is still insufficient."
The UN has harmed the cause of AIDS prevention by not acknowledging sooner that it had inflated the number of victims. But AIDS has hardly disappeared: 33.2 million people still takes your breath away.
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