SF Chronicle: Myths and misconceptions of the AIDS pandemic


Richard Moore

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Myths and misconceptions of the AIDS pandemic
James Chin
Sunday, March 11, 2007

Many myths and misconceptions about the AIDS pandemic are spread by the Joint 
United Nations Program on HIV/AIDS (UNAIDS) and other mainstream AIDS agencies 
and activists, either unintentionally out of ignorance or intentionally by 
distortion or exaggeration, including fear of a generalized epidemic.

UNAIDS continues to perpetuate the fallacy that only aggressive HIV/AIDS 
prevention programs -- especially directed at youth -- can prevent the eruption 
of heterosexual HIV epidemics where prevalence is currently low. More than two 
decades of observation and analysis point to far different conclusions -- there 
are no "next waves" of HIV epidemics just around the corner and the AIDS 
pandemic is now in its post-epidemic phase.

The highest HIV infection rates are found in many sub-Saharan African 
populations because up to 40 percent of adolescent and adult males and females 
in these populations routinely have multiple and concurrent sex partners, and 
they also have the highest prevalence of factors that can greatly facilitate 
sexual HIV transmission. In most other heterosexual populations, the patterns 
and frequency of sex-partner exchanges are not sufficient to sustain epidemic 
sexual HIV transmission.

UNAIDS and most AIDS activists reject this analysis as socially and politically 
incorrect, saying it further stigmatizes groups, such as injecting drug users, 
sex workers and men who have sex with men. However, all available epidemiologic 
data show that only the highest risk sexual behavior (multiple, concurrent and a
high frequency of changing partners) drives HIV epidemics among heterosexuals or
men who have sex with men, anywhere in the world.

Most AIDS activists claim, without any supporting data, that high HIV prevalence
in groups of men who have sex with men or injecting drug users will inevitably 
"bridge" over to the rest of the population and lead to "generalized" HIV 
epidemics. This entrenched myth persists even though there is little, if any, 
HIV spread into any "general" population except from infected injecting drug 
users and man who have sex with men or bisexuals to their regular sex partners.

Without a constant flow of alarming news releases warning about HIV being on the
brink of spreading into general populations, AIDS activists fear that the public
and policymakers will not continue to give AIDS programs the highest priority --
hence these "glorious myths," lies told for a noble cause.

This alarmism goes against all the evidence. Global and regional HIV rates have 
remained stable or have been decreasing during the past decade (except possibly 
among drug users in Eastern Europe). HIV has remained concentrated in groups 
with the riskiest behavior. Several decades of experience support the conclusion
that HIV is incapable of epidemic spread among the vast majority of 

Most of the public, policymakers and media have no inkling that the UNAIDS 
working assumption is inconsistent with established facts -- indeed, until 2006,
no major public health or international development agency had openly challenged
this assumption.

Some cracks in this wall of silence began to appear during 2006 with the 
publication of several studies which questioned the UNAIDS view.

Since 2000, dozens of population-based HIV sero-surveys have forced UNAIDS to 
reduce its overestimates in most high-HIV-prevalence countries by around 50 
percent or more: examples include Kenya's estimate in 2001 of 14 percent reduced
to 6.7 percent and Haiti's 2001 estimate of 6.1 percent reduced to 2.2 percent 
in 2006.

Estimates of HIV prevalence in China has been decreasing rather than increasing 
and the estimate now of more than 5 million HIV infections in India is likely to
be cut by half or more as the result of recent, and more accurate, studies.

In 2007, UNAIDS needs to come up with more realistic HIV estimates and 
projections, especially when more mainstream epidemiologists and the news media 
begin to question the basis of the UNAIDS assumption.

Continued denial of these realities will lead to further erosion of the 
credibility of UNAIDS and other mainstream AIDS agencies, raising the danger of 
people underestimating the real threats.

Regardless of my epidemiologic disagreements with UNAIDS, I totally agree with 
mainstream AIDS experts, who declare that this is no time to be complacent about
strengthening HIV treatment and, above all, HIV prevention programs.

Although many countries have overestimated their numbers, there are now at least
20 million HIV-infected people in sub-Saharan Africa and several million in Asia
and these numbers can be expected to remain close to these levels for a decade 
or more.

AIDS is a severe problem in sub-Saharan Africa and to a lesser extent in 
Caribbean countries and a few Southeast Asian countries, as well as among men 
who have sex with men, injecting drug users and sex workers throughout the 

This means that scarce health resources in countries with low HIV prevalence 
should be targeted primarily at those who are at the highest HIV risk, instead 
of being misdirected to the wider public.

We must cut through the overestimates of HIV prevalence and the exaggerated 
potential for generalized HIV epidemics so we can concentrate money and efforts 
on prevention and palliative care where it really matters.

James Chin, a professor of epidemiology at UC Berkeley, is a former chief of the
surveillance, forecasting and impact Assessment unit of the Global Program on 
AIDS of the World Health Organization. He is the author of "The AIDS Pandemic: 
the collision of epidemiology with political correctness" (Radcliffe, Oxford, 


This article appeared on page E - 5 of the San Francisco Chronicle

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