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WHO's counting?

From The Economist print edition

The global AIDS epidemic is still bad, but not as bad as it once

seemed

AP

At last, some relatively welcome news

ON THE face of things, a fall in the number of people infected with

HIV (the virus that causes AIDS) from 39.5m to 33.2m over the course

of a single year, as reported in this year's AIDS epidemic update

from the World Health Organisation (WHO) and UNAIDS, should be cause

for rejoicing. Indeed, it is, for it means there are fewer people to

treat, and fewer to pass the infection on, than was previously

thought. But the fall is not a real fall. Rather, it is due to a

change in the way the size of the epidemic is estimated.

If you factor in that change, the number of infected individuals has

actually risen since last year, by 500,000. Yet even that is not

necessarily bad news in the paradoxical world of AIDS. As treatment

programmes are rolled out around the world, death rates are falling.

According to the revised figures, the lethal peak, of 2.2m a year,

was in 2005. Now the figure is 2.1m. Since the only way for an

infected person to drop out of the statistics in reality (as opposed

to by sleight of statistical hand) is for him to die, such increased

survivorship inevitably pushes up the total size of the epidemic.

The best news of all, however, is that the new figures confirm what

had previously been suspected—that the epidemic has peaked. The

highest annual number of new infections around the world was 3.4m in

1998. That figure has now fallen to 2.5m.

Both the change in the death rate and the change in the infection

rate are partly a consequence of the natural flow and ebb of any

epidemic infection. But they are also a reflection of the hard graft

of public-health workers in many countries, who have persuaded

millions of people to modify or abandon risky behaviour, such as

having unprotected sex, as they have also created the medical

infrastructure needed to distribute anti-retroviral drugs that can

keep symptoms at bay in those who do become infected.

The revision of the figures is mainly a result of better data-

collection methods, particularly in India (which accounts for half

the downward revision) and five African countries (which account for

another fifth). In India many more sampling points have been

established, and in all countries better survey methods, relying on

surveyors knocking on doors rather than asking questions at clinics,

have gathered data from more representative samples.

Sceptics will feel vindicated by the revision. They have suspected

for a while that the older survey methods were biased, and that the

inflation thus produced was tolerated because it helped twang the

heart-strings of potential donors. However, the structures for

collecting and distributing money to combat AIDS are now well

established, and accurate data are crucial if that money is not to be

misdirected. The new information also means that the goal of

treatment for all who need it will be easier and cheaper to achieve.

The WHO and UNAIDS are planning to publish a report on the matter

early next year, but De Lay, UNAIDS's director of evidence,

monitoring and policy, says that the financial requirements for 2010

will probably be about 5% less than previously estimated, and that by

2015 that figure will have risen to 10%. Good news for everyone,

then, donors and sufferers alike.

http://www.economist.com/world/international/displaystory.cfm?

story_id=10180884

--- End forwarded message ---

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WHO's counting?

From The Economist print edition

The global AIDS epidemic is still bad, but not as bad as it once

seemed

AP

At last, some relatively welcome news

ON THE face of things, a fall in the number of people infected with

HIV (the virus that causes AIDS) from 39.5m to 33.2m over the course

of a single year, as reported in this year's AIDS epidemic update

from the World Health Organisation (WHO) and UNAIDS, should be cause

for rejoicing. Indeed, it is, for it means there are fewer people to

treat, and fewer to pass the infection on, than was previously

thought. But the fall is not a real fall. Rather, it is due to a

change in the way the size of the epidemic is estimated.

If you factor in that change, the number of infected individuals has

actually risen since last year, by 500,000. Yet even that is not

necessarily bad news in the paradoxical world of AIDS. As treatment

programmes are rolled out around the world, death rates are falling.

According to the revised figures, the lethal peak, of 2.2m a year,

was in 2005. Now the figure is 2.1m. Since the only way for an

infected person to drop out of the statistics in reality (as opposed

to by sleight of statistical hand) is for him to die, such increased

survivorship inevitably pushes up the total size of the epidemic.

The best news of all, however, is that the new figures confirm what

had previously been suspected—that the epidemic has peaked. The

highest annual number of new infections around the world was 3.4m in

1998. That figure has now fallen to 2.5m.

Both the change in the death rate and the change in the infection

rate are partly a consequence of the natural flow and ebb of any

epidemic infection. But they are also a reflection of the hard graft

of public-health workers in many countries, who have persuaded

millions of people to modify or abandon risky behaviour, such as

having unprotected sex, as they have also created the medical

infrastructure needed to distribute anti-retroviral drugs that can

keep symptoms at bay in those who do become infected.

The revision of the figures is mainly a result of better data-

collection methods, particularly in India (which accounts for half

the downward revision) and five African countries (which account for

another fifth). In India many more sampling points have been

established, and in all countries better survey methods, relying on

surveyors knocking on doors rather than asking questions at clinics,

have gathered data from more representative samples.

Sceptics will feel vindicated by the revision. They have suspected

for a while that the older survey methods were biased, and that the

inflation thus produced was tolerated because it helped twang the

heart-strings of potential donors. However, the structures for

collecting and distributing money to combat AIDS are now well

established, and accurate data are crucial if that money is not to be

misdirected. The new information also means that the goal of

treatment for all who need it will be easier and cheaper to achieve.

The WHO and UNAIDS are planning to publish a report on the matter

early next year, but De Lay, UNAIDS's director of evidence,

monitoring and policy, says that the financial requirements for 2010

will probably be about 5% less than previously estimated, and that by

2015 that figure will have risen to 10%. Good news for everyone,

then, donors and sufferers alike.

http://www.economist.com/world/international/displaystory.cfm?

story_id=10180884

--- End forwarded message ---

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