Overblown AIDS Figures

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A_Wanderer

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JOHANNESBURG, Nov. 19 -- The United Nations' top AIDS scientists plan to acknowledge this week that they have long overestimated both the size and the course of the epidemic, which they now believe has been slowing for nearly a decade, according to U.N. documents prepared for the announcement.

AIDS remains a devastating public health crisis in the most heavily affected areas of sub-Saharan Africa. But the far-reaching revisions amount to at least a partial acknowledgment of criticisms long leveled by outside researchers who disputed the U.N. portrayal of an ever-expanding global epidemic.

The latest estimates, due to be released publicly Tuesday, 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.

Having millions fewer people with a lethal contagious disease is good news. Some researchers, however, contend that persistent overestimates in the widely quoted U.N. reports have long skewed funding decisions and obscured potential lessons about how to slow the spread of HIV. Critics have also said that U.N. officials overstated the extent of 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 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 the report had not been released publicly. In documents obtained by The Washington Post, U.N. officials say the revisions stemmed mainly from better measurements rather than fundamental shifts in the epidemic. They also say they are continually seeking to improve their tracking of AIDS with the latest available tools.

Among the reasons for the overestimate is methodology; U.N. officials traditionally based their national HIV estimates on infection rates among pregnant women receiving prenatal care. As a group, such women were younger, more urban, wealthier and likely to be more sexually active than populations as a whole, according to recent studies.

The United Nations' 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, reaching as much as $10 billion a year.

But in its role in tracking the spread of the epidemic and recommending strategies to combat it, UNAIDS has drawn criticism in recent years from Epstein and others who have accused it of being politicized and not scientifically rigorous.

For years, UNAIDS reports have portrayed an epidemic that threatened to burst beyond its epicenter in southern Africa to generate 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 those 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 agency's tools for measuring and predicting the course of 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. For example, the United Nations has cut its estimate of HIV cases in India by more than half because of a study completed this year. This week's report also includes major cuts to U.N. estimates for Nigeria, Mozambique and Zimbabwe.

The revisions affect not just current numbers 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 at that time was 30 million, the new report says.

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 who has long been critical of UNAIDS, said that 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, Calif.

The picture of the AIDS epidemic portrayed by the newer studies, and set to be endorsed by U.N. scientists, shows a massive concentration of infections in the southern third of Africa, with nations such as Swaziland and Botswana reporting 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, and regional variations in sexual behavior are the biggest factors determining the severity of the AIDS epidemic in different countries and even within countries.

Beyond Africa, AIDS 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.
link
 
"Beyond Africa, AIDS 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."
 
The danger in misrepresenting (whether intentional or not) is the loss of credibility. Suddenly what is still a horrific number seems less horrifying by comparison. Ultimately misrepresentation damages your cause.
 
Exactly.

And that's what I'm curious about, if this number screw-up was accidental (which I can see it being-when you're dealing with many, many people, numbers are more likely to be inaccurate), or if it was intentional? 'Cause if it was the latter, that's pretty stupid...like BonosSaint said, it really doesn't help your cause. Just be honest, and if you don't know exact numbers, say so and give a reasonable estimate.

Anywho, I'm glad to hear that the number's less than originally thought, that's certainly some good news. Hopefully this problem with the numbers won't be an obstacle in giving help to those who are suffering.

Angela
 
Some more good bad news
IGNORE the fuss over the news last week — the United Nations’ AIDS-fighting agency admits to overestimating the global epidemic by six million people. That was a sampling error, an epidemiologist’s Dewey Defeats Truman.

Look instead at the fact that glares out from the Orwellian but necessary revision of the figures for earlier years. There it is, starkly: AIDS has peaked.

New infections reached a high point in the late 1990’s — by the best estimate, in 1998.

There must have been such moments in the past — perhaps A.D. 543, when Constantinople realized it would survive the Plague of Justinian, or 1351 in medieval Europe, when hope dawned that the Black Death would not claw down everyone.

Eleven years ago, there was a milestone moment in AIDS history when Andrew Sullivan wrote an article in The New York Times Magazine titled “When Plagues End.” It argued that a new treatment, the triple therapy cocktail, meant it was finally possible to envision AIDS as a chronic illness, not an inevitable death sentence.

Naturally, he was, in his words, “flayed alive” by the AIDS establishment. An end in sight implied that vigilance could relax — although he hadn’t actually argued that.

Mr. Sullivan’s view was solipsistic. It celebrated hope for gay American men still reveling in their sexual freedom and barely mentioned the wider reality of newborn babies and faithful wives in Africa who were never to enjoy any freedoms and still were doomed to die miserably in numbers that would blast the exit doors off every gay bar in North America.

Now, out of the mists of the old data, another such moment has emerged, one for the worldwide stage.

The first thing experts are again quick to say is that it doesn’t mean anyone can relax.

More than three million annual new infections in 1998, or an estimated 2.5 million for 2007, “is not a particularly happy plateau,” said Dr. Robert Gallo, a discoverer of the AIDS virus.

Dr. Mark R. Dybul, the Bush administration’s global AIDS coordinator, added: “I don’t think it radically shifts our thinking, at least not for 5 to 10 years. We still need to prevent 2.5 million infections, we still need to prevent 2.1 million a year from dying.”


...



This does not mean that shrinking numbers are inevitable.

The disease is still rooting out new pockets; infections are rising in Vietnam, Uzbekistan and even Indonesia, the world’s fourth-most-populous country.

It can also lull its hosts into acting foolishly again; that has happened in San Francisco and Germany, Dr. De Lay noted, where new infections are ticking up again as young gay men revive the bar scene of the 1980’s.

And, Dr. Gallo warned, a mutation — a virus more easily transmitted or more drug resistant — could emerge. Epidemics traditionally move in waves; that could trigger a second.

Nonetheless, the new estimates mean the vision Mr. Sullivan had of the American epidemic is now possible for the global one: a day when AIDS is viewed as a chronic problem, another viral predator taking down the careless or weak members of the herd, as pneumonia takes down the old ones.

Also possible in the future — the very distant future, Dr. Dybul warned — is a day when the calculation I tried to do will have an answer that is actually affordable.

After all, even the Black Death is not dead. But it is cornered, and very cheaply. Its cause, Yersinia pestis, lives on in fleas and rodents, and there are about 2,000 cases each year, a handful of them in the American Southwest. But penicillin kills it.

Nothing yet kills AIDS. When that day comes, another rewrite of the epidemic’s history will begin.

Nonetheless, the disease is at last giving notice that it will behave like other pestilences.
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[q]Nonetheless, the disease is at last giving notice that it will behave like other pestilences.[/q]



and a vaccine is still 20+ years off.

don't whip off those rubbers just yet.
 
Honestly, I've always been more disturbed by infection rates in specific locales rather than the actual number of infected persons. In many areas, more than 50% (sometimes more like 80%) of people are infected. Infection rates like that are severely damaging to local economies, regardless of the actual count.
 
BonosSaint said:
The danger in misrepresenting (whether intentional or not) is the loss of credibility. Suddenly what is still a horrific number seems less horrifying by comparison. Ultimately misrepresentation damages your cause.

:yes: Which is a shame, because the cause is good.
 
the iron horse said:
"Beyond Africa, AIDS 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."



not so in DC. is it so easy to write off, say, straight black people in the way that it is to write off drug users, prostitutes, and gay men?

[q]Study Calls HIV in D.C. A 'Modern Epidemic'
More Than 80 Percent Of Recent Cases Were Among Black Residents

By Susan Levine
Washington Post Staff Writer
Monday, November 26, 2007; A01

The first statistics ever amassed on HIV in the District, released today in a sweeping report, reveal "a modern epidemic" remarkable for its size, complexity and reach into all parts of the city.

The numbers most starkly illustrate HIV's impact on the African American community. More than 80 percent of the 3,269 HIV cases identified between 2001 and 2006 were among black men, women and adolescents. Among women who tested positive, a rising percentage of local cases, nine of 10 were African American.

The 120-page report, which includes the city's first AIDS update since 2000, shows how a condition once considered a gay disease has moved into the general population. HIV was spread through heterosexual contact in more than 37 percent of the District's cases detected in that time period, in contrast to the 25 percent of cases attributable to men having sex with men.

"It blows the stereotype out of the water," said Shannon Hader, who became head of the District's HIV/AIDS Administration in October. Increases by sex, age and ward over the past six years underscore her blunt conclusion that "HIV is everybody's disease here."

The new numbers are a statistical snapshot, not an estimate of the prevalence of infection in the District, which is nearly 60 percent black. Hader, an epidemiologist and public health physician who has worked on the disease in this country and internationally, said previous projections remain valid: One in 20 city residents is thought to have HIV and 1 in 50 residents to have AIDS, the advanced manifestation of the virus.

Almost 12,500 people in the District were known to have HIV or AIDS in 2006, according to the report. Figures suggest that the number of new HIV cases began declining in 2003, but the administration said the drop more likely reflects underreporting or delayed reporting. A quarter-century into the epidemic, the city's cumulative number of AIDS cases exceeds 17,400.

"HIV/AIDS in the District has become a modern epidemic with complexities and challenges that continue to threaten the lives and well-being of far too many residents," the report states.[/q]
 
diamond said:
the key is circumcision.

dbs



Let me get this straight, the removal of the foreskin allows the magical force-field to appear therefore filtering HIV from the sperm as it exits. wow. So according to this it's only those with intact foreskins that can contract HIV or AIDS.
To think that the solution has been right there in our faces this whole time.:tsk:




I really hope you weren't serious with this statement:sad:
 
Mmmmmm, yeah, because circumcision matters when a mother is passing HIV "horizontally" or "vertically" to her child....

:eyebrow:
 
cinnaminson said:




Let me get this straight, the removal of the foreskin allows the magical force-field to appear therefore filtering HIV from the sperm as it exits. wow. So according to this it's only those with intact foreskins that can contract HIV or AIDS.
To think that the solution has been right there in our faces this whole time.:tsk:




I really hope you weren't serious with this statement:sad:

Not quite, but read this:

Adult Male Circumcision Significantly Reduces Risk of Acquiring HIV
Trials in Kenya and Uganda Stopped Early
The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), announced an early end to two clinical trials of adult male circumcision because an interim review of trial data revealed that medically performed circumcision significantly reduces a man's risk of acquiring HIV through heterosexual intercourse. The trial in Kisumu, Kenya, of 2,784 HIV-negative men showed a 53 percent reduction of HIV acquisition in circumcised men relative to uncircumcised men, while a trial of 4,996 HIV-negative men in Rakai, Uganda, showed that HIV acquisition was reduced by 48 percent in circumcised men.

"These findings are of great interest to public health policy makers who are developing and implementing comprehensive HIV prevention programs,"says NIH Director Elias A. Zerhouni, M.D. "Male circumcision performed safely in a medical environment complements other HIV prevention strategies and could lessen the burden of HIV/AIDS, especially in countries in sub-Saharan Africa where, according to the 2006 estimates from UNAIDS, 2.8 million new infections occurred in a single year."

"Many studies have suggested that male circumcision plays a role in protecting against HIV acquisition," notes NIAID Director Anthony S. Fauci, M.D. "We now have confirmation — from large, carefully controlled, randomized clinical trials — showing definitively that medically performed circumcision can significantly lower the risk of adult males contracting HIV through heterosexual intercourse. While the initial benefit will be fewer HIV infections in men, ultimately adult male circumcision could lead to fewer infections in women in those areas of the world where HIV is spread primarily through heterosexual intercourse."

The findings from the African studies may have less impact on the epidemic in the United States for several reasons. In the United States, most men have been circumcised. Also, there is a lower prevalence of HIV. Moreover, most infections among men in the United States are in men who have sex with men, for whom the amount of benefit provided by circumcision is unknown. Nonetheless, the overall findings of the African studies are likely to be broadly relevant regardless of geographic location: a man at sexual risk who is uncircumcised is more likely than a man who is circumcised to become infected with HIV. Still, circumcision is only part of a broader HIV prevention strategy that includes limiting the number of sexual partners and using condoms during intercourse.

The co-principal investigators of the Kenyan trial are Robert Bailey, Ph.D., M.P.H., of the University of Illinois at Chicago, and Stephen Moses, M.D., M.P.H., University of Manitoba, Canada. In addition to NIAID support, the Kenyan trial was funded by the Canadian Institutes of Health Research and included Kenyan researchers Jeckoniah Ndinya-Achola, M.B.Ch.B., and Kawango Agot, Ph.D., M.P.H. The Ugandan trial is led by Ronald Gray, M.B.B.S., M.Sc., of Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Additional collaborators in the Ugandan trial were David Serwadda, M.Med., M.Sc., M.P.H., Nelson Sewankambo, M.B.Ch.B., M.Med.M.Sc., Stephen Watya, M.B.Ch.B., M.Med., and Godfrey Kigozi, M.B.Ch.B., M.P.H.

Both trials involved adult, HIV-negative heterosexual male volunteers assigned at random to either intervention (circumcision performed by trained medical professionals in a clinic setting) or no intervention (no circumcision). All participants were extensively counseled in HIV prevention and risk reduction techniques.

Both trials reached their enrollment targets by September 2005 and were originally designed to continue follow-up until mid-2007. However, at the regularly scheduled meeting of the NIAID Data and Safety Monitoring Board (DSMB) on December 12, 2006, reviewers assessed the interim data and deemed medically performed circumcision safe and effective in reducing HIV acquisition in both trials. They therefore recommended the two studies be halted early. All men who were randomized into the non-intervention arms will now be offered circumcision.

"It is critical to emphasize that these clinical trials demonstrated that medical circumcision is safe and effective when the procedure is performed by medically trained professionals and when patients receive appropriate care during the healing period following surgery," notes Dr. Fauci.

Researchers have noted significant variations in HIV prevalence that seemed, at least in certain African and Asian countries, to be associated with levels of male circumcision in the community. In areas where circumcision is common, HIV prevalence tends to be lower; conversely, areas of higher HIV prevalence overlapped with regions where male circumcision is not commonly practiced.

Results of the first randomized clinical trial assessing the protective value of male circumcision against HIV infection, conducted by a team of French and South African researchers in South Africa, were reported in 2005. That trial of more than 3,000 HIV-negative men showed that circumcision reduced the risk of acquiring HIV by 60 percent. The trial was funded by the French Agence Nationale de Recherches sur le Sida (ANRS) (see http://www.anrs.fr/).

For more information on the Kenyan and Ugandan trials of adult male circumcision, see the NIAID Questions and Answers document at http://www3.niaid.nih.gov/news/QA/AMC12_QA.htm.

The World Health Organization (WHO) press statement in response to the NIAID DSMB recommendation is available on the WHO web site, www.who.int/hiv.

U.S. Broadcast Media: B-roll of the Rakai site can be downlinked from a satellite feed from 2:15 to 3:00 p.m. Eastern time. Test time will be 2:15-2:30 p.m.; the B-roll footage will be downlinked from 2:30-3:00 p.m. If you have technical problems, call 703-642-8585. The coordinates are as follows:

Galaxy 3 transponder 21 C-Band
DLF 4120 Horizontal
ULF 6345 Vertical
Audio 6.2/6/8

News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

NIAID is a component of the National Institutes of Health. NIAID supports basic and applied research to prevent, diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on basic immunology, transplantation and immune-related disorders, including autoimmune diseases, asthma and allergies.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
 
Let's just say it's one of the many keys in reducing HIV significantly in Africa.

How about that?
:D

dbs
 
Let's just say that with education and the access to condoms you wouldn't have to go that route.

You're forcing your culture, I'd rather let those that are comfortable with what God gave them keep what God gave them. Unless of course you want to say God's design is flawed?
 
diamond said:
Let's just say it's one of the many keys in reducing HIV significantly in Africa.

How about that?
:D

dbs



this is correct, to an extent.

HIV is passed from female to male as a result of small tears in the head of the penis that's protected by foreskin, and the head is much more delicate in uncircumsized men and thus more likely to tear.
 
Huffington Post

World AIDS Day: Putting a Human Face on the Numbers

Posted November 27, 2007 | 02:59 PM (EST)

The recent announcement by UNAIDS and the World Health Organization that they may have overestimated the number of HIV positive people worldwide by as much as 20 percent has obscured the two most important issues that should be discussed this World AIDS Day. The first is the extraordinary success of the billion dollar initiatives of the past six years, which have resulted in putting over a million people in developing countries on anti-retroviral therapy. The second is that, despite this success, we continue to fail to meet the larger need: last year more than two million people died from AIDS -- nearly all in the developing world, 78 percent in sub-Saharan Africa alone.

How has it happened that the international news story should focus on statistical abstractions rather than the human face of the continuing pandemic? There are those who would lay responsibility at the feet of UN, and to be sure, they bear a good deal of blame. Despite the warnings of health experts and observers, the UN was content to oversimplify, accepting data without critical review or revision. Now, critics are blasting the sloppy results, while the toll of the disease on individuals may be lost amidst the noise.

It's important this doesn't happen. An overlooked reason for the suffering of Africans was a fundamental breakdown in health systems which allowed HIV to thrive, undiagnosed and untreated, for several decades. AIDS is now estimated to have emerged in central Africa in the 1940s, and as epidemiological forensics improve, that date may roll back substantially. Through the 1960s and '70s, a deadly "slimming" disease destroyed swaths of humanity long before hitting our radar screen in the early 1980s. Decades of underinvestment in the public health system and the utter exclusion of services for the poor made it possible for the international community to miss the disease until it was globally established.

AIDS is now treatable but this requires well-trained health professionals, infrastructure, and management. Rwanda, where I work and live, is a crucible of sorts for the pandemic. Before the emergence of the Global Fund to Fight AIDS, Tuberculosis and Malaria just five years ago, Rwandans who had AIDS simply died. With financing from the U.S. government and the Global Fund, surveillance and testing of HIV improved dramatically, and effective treatment began. By 2004, testing in urban clinics indicated that from 10-30 percent of women showing up for pre-natal care were HIV positive.

It was figures like these that, until recently, informed data analysis which led to higher figures of AIDS prevalence. In Rwanda, these initial studies implied a 12-15 percent overall prevalence of HIV in the population. Previous studies had shown that any time prevalence moves above the five percent mark (five times higher than the international average), epidemics can grow to staggering proportions, as was seen in Botswana where nearly half of all adults are HIV positive.

Rwanda recognized the potential catastrophe and took quick action. It designed new strategies and programs, streamlined management, and attracted international donor money. From the head of state to local leaders, the country was engaged in fighting the virus.

In the past couple of years, it's become apparent that Rwanda didn't have the whole picture. It's prevalence rate is closer to three to five percent -- far below what had been originally estimated. While this figure is a relief, enormous challenges test the public health infrastructure. Understaffed health centers without running water are hard pressed to deliver HIV/AIDS services. AIDS funding that has been committed to Rwanda, even when the higher statistics prevailed, has gone into much-needed medical and management training and infrastructure improvement, providing a better health setting for all patients.

While the numbers of people living with HIV may have been exaggerated due to poor data, the consequences of not doing more to serve the needs of the poor have not been. Millions in sub-Saharan Africa continue to go untreated and undiagnosed, and more -- not less -- needs to be done. The real question this World AIDS Day is not, "how did we miscount the infected by 6 million?" but rather, "how did we allow another 2.1 million to perish from a treatable disease and another 2.5 million to be infected?"

Josh Ruxin is Assistant Clinical Professor of Public Health at the Mailman School of Public Health at Columbia University and Director of the Access Project in Rwanda.
 
thanks for posting that article Diamond, it's great to see someone who actually has something to back them up and not just resort to emotional name calling.:up:

I also agree with BonoVoxSuperstar. Education and free condoms are the ONLY thing that will work. Relying on circumcision is just too risky.
 
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