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Assessing AIDS In some African countries, the toll is lower than what the U.N. told us. EDITORIAL
  EDITORIAL in Washington Post
Monday, April 10, 2006; Page A16
EACH YEAR, the United Nations releases an update on the state of AIDS, and its statistics are cited around the world in hundreds of reports and articles. In general, the U.N. data have painted a grim picture of the virus's inexorable advance. But a report last week by The Post's Craig Timberg forces a reexamination of these views. In some parts of Africa, it seems, AIDS has advanced less than the United Nations had suggested.
New studies cited in Mr. Timberg's article suggest that in Botswana 34.9 percent of adults 15 to 49 are infected with the HIV virus, slightly less than the 37.3 percent reported by the United Nations. The proportion infected in South Africa stands at 16.2 percent, considerably lower than the 21.5 percent claimed by the United Nations. But Rwanda's rate is only 3 percent. Back in the mid-1980s, some researchers were saying that Rwanda might have an infection rate of 30 percent, and the United Nations claimed a rate of 11.2 percent in 2000.
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The United Nations' credibility on AIDS will now suffer. It's been clear for a while that UNAIDS, the agency responsible for these statistics, was reluctant to contemplate good strategies for fighting AIDS lest these undermine global support for expanded funding. Frustrated AIDS experts have pointed out that, in a world of inevitably limited resources, it makes sense to target prevention efforts at high-risk groups: Although everybody in a hard-hit country may be at risk, prostitutes or truck drivers with multiple sexual partners pose a disproportionately large risk to others. But UNAIDS has worried that, by endorsing narrowly targeted AIDS strategies, it might split the coalition in favor of expanded resources. Now the organization appears to have published dubious AIDS data. Although it has amended its reports in light of new studies, it did not lead the effort to improve the quality of its statistics.
The credibility of the United Nations matters less than the reaction of health officials in poor countries and donor agencies. There has long been a concern that AIDS, while underfunded relative to the number of people in need of treatment and education, is arguably overfunded relative to other diseases. Prolonging the life of an HIV-positive adult is expensive and difficult; preventing malaria with low-tech mosquito nets may be more cost-effective. The revisions of the AIDS data should prompt a reopening of such questions. But AIDS remains likely to emerge from this necessary intellectual process as a top policy priority. It tends to strike poor countries' skilled urban people, leaving behind a generation of orphans and puncturing hopes of development progress. Moreover, although AIDS is not the poor world's leading killer, it has demonstrated a capacity in some places for terrifyingly fast growth. Even Botswana's revised infection rate of 34.9 percent is devastating.
Report: AIDS in Africa may be overstated
Although most global researchers estimate the HIV prevalence rate in a country based on the percentage of pregnant women at prenatal clinics found to be HIV-positive, that approach could be producing wildly inaccurate estimates, The Washington Post reports. In Rwanda, for example, the United Nations estimated the HIV prevalence rate to be 13%, but a new nationwide HIV survey shows that among residents ages 15 to 49 the rate is actually about 3%. Some groups had claimed Rwanda's rate was as high as 30%.
Researchers say using data from prenatal clinics results doesn't reflect the true nature of the disease in a country. The estimates were skewed in favor of young, sexually active women in areas with prenatal clinics, typically larger cities. Nation-by-nation surveys have shown that these urban areas have much higher HIV rates than a country's general population.
These statistical modeling approaches have greatly overestimated the spread of the disease in eastern and western Africa, they say. But the estimates are much more accurate in southern Africa, where HIV's impact is far greater than in other parts of the continent, according to researchers. HIV prevalence rates are alarmingly high in South Africa, Botswana, Swaziland, and Zimbabwe.
In Botswana numerous studies have shown that about 35% of the nation's adults are HIV-positive; in Francistown, Botswana's second-largest city, nearly 45% of men and 70% of women ages 30 to 34 are infected. (The Advocate)
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