03 December 2007

Okay, Jason, here's something for you to comment on

Okay, even being in the midst of exams I had to comment on this one.

UNAIDS has recently revised its estimates for the number of people living with HIV/AIDS. The 2007 estimate was reduced to 33.2 million (down from 39.5 million in 2006). Report here.

This has lead to a fair bit of controversy, to the point where even relatively uninformed Leigh-Anne has stumbled upon multiple articles commenting on it in the past week.

Stephen Lewis made a speech at the World Health Editors Network in London, commenting that the revision "undermined public confidence in the reliability of the figures, introducing completely unnecessary levels of doubt, contention and confusion" (quoted at EATG and if that isn't reliable enough for you just google "World Health Editors Network" AND "Stephen Lewis"). He also pointed out that statisticians and epidemiologists have been calling for a revision for quite some time, that there was too much of a focus on statistics, thus failing to address the human tragedy, and that regardless the amount of aid still runs short of where it needs to be.

At least he acknowledged that UNAIDS did not maintain artificially high estimates in an attempt to garner more aid. I've seen this come up in some of the commentary and it's quite ridiculous. If that were the case, why bother revising the estimates in the first place?

The second point I agree with is that there is still so much that can be done to help tame the epidemic regardless of decreased estimates. Obviously.

However, I just can't bring myself to shift most of the blame to UNAIDS. Sure, maybe this will cause the general public to "doubt, contention and confusion" but if it's possible to improve the methodology for collecting data it is absolutely necessary. Accuracy is almost never unnecessary. Even if there are papers floating around in academia with ideas for improving the methodology, simply writing a paper will not solve the world's problems. You need to put some effort in if you'd like your idea to be implemented on a large scale. Come on, it's not like estimating the prevalence of a worldwide disease is a small job.

Also, how can you expect a statistical report to properly assess the human tragedy? In AIDS in Context we often talk about the effectiveness of making emotional connections, but any AIC-er can tell you that talking about emotional connections and actually creating them are two profoundly different things. The World Vision approach is completely overdone so what do we do now? One musn't talk flippantly about creating an understanding of human tragedy.

Another thing brought up in the UN report is that changing prevalence rates in India have legitimately affected the statistic. I think this is fair, but this is possibly because India is the quintessential example of generic ARVs having a significant effect on a population. In fact, since 1994, Cipla in Mumbai has launched 10 different types of ARVs, with the price of therapy constantly dropping. Generic HAART (Highly Active Anti-Retroviral Therapy) can be bought for $250 USD a year, less than it costs to monitor CD4 counts and viral load. Definitely more people are receiving treatment, and thus transmission would also be down due to the effects of the ARVs. However, don't forget that correctly administered ARV therapy requires skilled and dedicated physicians to avoid ARV failure and resistance. With the current influx of ARVs, I'm not sure if this is happening, but I guess that just means I need to do more research (stats from a Lancet report here - subscription needed; if you're connected to the UBC VPN you'll be fine or email me if you have problems)

Yet another thing to consider is that ARV availability has not taken a positive upturn everywhere like it has in India. This statistic measures number of people living with AIDS, not number of cases contracted and we musn't be mesmerized by the successes in India and forget that there are still many who don't get the treatment they need (assuming they want it). This is a very roundabout way of saying that some people are still dying shortly after being infected.

A good point made by David Ng at Terry is that regardless of the actual number, HIV/AIDS is still a pertinent global issue that we need to keep caring about and acting on. It's not like the situation is any less important.