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In global public health, it’s politics versus patients
Part I: WHO AIDS Estimates Crumble


Philip Stevens
Medical Progress Today
July 18, 2008

Last month, the head of HIV/AIDS at the World Health Organization (WHO) told a British newspaper that there will be no general, heterosexual AIDS pandemic outside Sub-Saharan Africa. This admission flipped on its head almost two decades of UN-sponsored AIDS alarmism, in which almost every AIDS agency and activist maintained that it was only a matter of time until heterosexual populations all over the world would be decimated by the disease.

Of course, scientists had known for some time that such a global heterosexual AIDS pandemic is epidemiologically impossible. According to Professor Jim Chin, the epidemiologist that helped the WHO design its AIDS surveillance methodologies in the 1980s, UNAIDS has for years misled the public on this issue. Back in 1997, for example, Peter Piot claimed that AIDS would cut through Asian populations 'like a hot knife through butter'. It never happened.

One could reasonably ask why it has taken so long for public AIDS agencies to accept these facts, despite them being widely available for years. The answer is that AIDS—like so many areas of global public health, from malaria to drug patents—is dominated by interest groups, political correctness and tightly-defended funding streams. The result is health policy that is formed more by politics than clinical need; in many cases with devastating consequences.

For many years, Professor Chin ploughed a lonely furrow making the case that UNAIDS was wrong on AIDS. Latterly, however, he has been publicly joined by other epidemiologists such as Elisabeth Pisani and Daniel Halperin at Harvard. Now that the WHO has apparently also adopted this position, it seems like a major myth of global health has been finally laid to rest.

In his paper 'The myth of a general AIDS pandemic', Professor Chin argues that UNAIDS has been very successful in raising unprecedented global financial support for HIV/AIDS programmes, but has achieved this by 'grossly exaggerating the scope and trend' of the pandemic. While Professor Chin stops short of accusing the agency of deliberately lying, his implication is that UNAIDS has depended on inaccurate alarmism to ensure a continued flow of funds to the innumerable NGOs, government programmes and activist groups that constitute the AIDS industry.

While no-one is denying that AIDS remains an extremely serious problem in certain parts of sub-Saharan Africa, UNAIDS' distortions have had serious implications for global health. Because AIDS budgets in many African countries are now often bigger than the entire national health budget, this has led to distortions in the provision of overall primary care, with carers, clinicians and other scarce resources being diverted into AIDS, undermining funding for basic health services.

On top of this, there are the macroeconomic implications of pouring billions of dollars of hard foreign currency into fragile African economies. In 2004, the IMF warned of the dangers of increasing aid flows for HIV/AIDS: large inflows of foreign currency raise local exchange rates, hitting exports; inflation increases when aid funds are spent locally on "non-tradable goods"; and domestic interest rates will be pushed up, thereby squeezing social spending by raising public debt service payments. These all hurt the poor the most.

Meanwhile, we are failing to get the basics right. According to Professor Chin, "easily preventable diseases are still killing millions of children each year, while billions of dollars are being squandered annually by AIDS programmes to prevent HIV infections in populations who are not at risk."

Part of the reason why global AIDS policy has become divorced from reality is the power that activist groups now have on policymaking, particularly at the UN level. Following the fall of the Berlin Wall, the UN has shifted its focus from international security issues to social and economic development. While NGOs have always had an arms-length consultative status with the UN under Article 71 of the UN charter, the 1990s saw the NGOs become far more deeply integrated into the machinery of UN policy development and implementation, actively encouraged by UN Secretaries General such as Kofi Annan.

But, despite their claims to represent the interests of the poor, only a few hundred of the several thousand NGOs registered at the UN come from developing countries; the vast majority are from the United States. Furthermore, rather than representing the diverse interests of a nebulous group known as the 'global poor', they frequently represent little more than the narrow interests of their members.

The recent history of AIDS bears this out. Epidemiologists and health economists are almost united in believing that the disease will only be reversed if attention is paid to prevention. In poor countries, the lack of workable health infrastructure makes rolling out complex treatment programmes extremely difficult and costly, and more lives could have been saved if prevention was made a priority earlier.

Next week: Part II, Ideology Unhinged

Philip Stevens is director of policy at International Policy Network, a London-based development think tank.

 
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