In a passionate speech at the World Health Editors Network in London, a former United Nations Special Envoy for AIDS in Africa and Co-Director of AIDS-Free World, Stephen Lewis, warned that a recent UNAIDS document reporting decreased HIV infections has “undermined public confidence in the reliability of the figures, introducing completely unnecessary levels of doubt, contention and confusion”. Describing the UN as “stubborn and sloppy”, he expressed concern that the report does nothing to convince the world that we are “billions and billions of dollars behind, when it comes to funding all the components of the pandemic, from orphans to second line drugs.”
In its latest report, UNAIDS cut the number of infections worldwide to about 32.7 million, down from its estimated 39.5 million in 2006. Rather than a reduction based on decreased rates of infection, the new figure was mainly due to fixing flawed statistics from previous reports. The former data collection methods relied heavily on “sentinel-site surveillance” which extrapolates data gathered at prenatal clinics. An assumption was made that the rate of HIV in the general population would be similar to the rate among pregnant women in urban clinics. This year the UN attributed more of their calculations to national surveys and blood-testing.
While it’s good news that fewer people are infected than previously thought, there was concern that the dramatic re-representation of the figures would result in diverted resources from an epidemic still in desperate need of funds.
“For years, knowledgeable epidemiologists have been telling the UN that the figures were too high. They didn't whisper their criticisms: they wrote books and articles,” Lewis said. “But the UN chose a course of delay and dithering. It can never admit that it's wrong. So finally, and predictably, came the moment of truth: the result is an overall prevalence rate that is lower by almost seven million than last year's estimate.”
Lewis also expressed anger that the report did not address the human tragedy and focused too much on statistics.
“The new estimates confirm a continuing apocalypse for sub-Saharan Africa: 22.5 million infections, 61% of them women, 68% of worldwide infections, 76% of all deaths, 11.4 million orphans. This is where the focus must be, this is where it should always have been; not a report cluttered by mathematical adjustments so that virtually every story that’s written begins with the news of a statistical volte-face. If the recording of data had been more scrupulous all along, we could have welcomed this report,” he said. “Instead, all of us have to run to the trenches to remind the world that more money is still desperately needed.”
Lewis also highlighted several flaws in the data which could lead to yet another recalculation. For example, the narrative evidence of the report states repeatedly that Mozambique has shown no decrease in infection rates yet later asserts that Mozambique is one of the six countries in the world that has most significantly contributed to the reduced numbers seen in the report. No data on Mozambique are set out conclusively in the report.
In conclusion, Lewis stressed that more should be done no matter what statistical calculation is applied to the figures.
“Whether it's 40 million or 33 million, this plague continues to ravage humankind. I simply do not believe that the United Nations has done everything it can possibly do to turn the tide,” he said.