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AIDS Has Not Devastated East and West Africa
April 06, 2006
Trevor Butterworth

Excellent Washington Post story maps the evolution of flawed data.

In a stunning front-page article in the Thursday 6 edition of the Washington Post, the paper reported that AIDS has turned out to be much less devastating in East and West Africa than longstanding estimates by the U.N. and other early researchers once claimed.

In Rwanda, “The new data suggest the rate never reached the 30 percent estimated by some early researchers, nor the nearly 13 percent given by the United Nations in 1998.

In fact, the HIV infection rate was just three percent among Rwandans age 15 to 49. The situation is similar with other countries in East and West Africa – but not in southern Africa, where the newer, more reliable data shows AIDS to be as great a problem as previously judged.

This excellent example of analytical journalism raised and addressed a critical, if politically unpleasant, point: How much did the errant data result from employing survey methods that were based on reasonable premises that later turned out to be false – or from flawed premises that could have been corrected quickly but weren't, due to a political desire to draw attention to the problem?

According to the Post’s reporting, the false data
“flowed from the long-held assumption that the extent of infection among pregnant women who attended prenatal clinics provided a rough proxy for the rate among all working-age adults in a country.
But the women who attended prenatal clinics were not a representative of the general population – they tended to by younger, urban, sexually-active women. As the Post reported,
”The new studies rely on random testing conducted across entire countries, rather than just among pregnant women, and they generally require two forms of blood testing to guard against the numerous false positive results that inflated early estimates of the disease. These studies also are far more effective at measuring the often dramatic variations in infection rates between rural and urban people and between men and women.
Yet the Post also reported that there were concerns about the accuracy and effectiveness of the initial estimates.
“...many researchers say the United Nations' reliance on rigorous science waned after it created the separate AIDS agency in 1995 -- the first time the world body had taken this approach to tackle a single disease…
In the place of previous estimates provided by the World Health Organization, outside researchers say, the AIDS agency produced reports that increasingly were subject to political calculations, with the emphasis on raising awareness and money.”

"From a research point of view, they've done a pathetic job," said Paul Bennell, a British economist whose studies of the impact of AIDS on African school systems have shown mortality far below what UNAIDS had predicted. "They were not predisposed, let's put it that way, to weigh the counterevidence. They were looking to generate big bucks."

One unfortunate result of determining AIDS to be far worse than it turned out to be is that it obscured evaluating which health campaigns and interventions were working and which weren’t. And then there is the unexplored issue of how the overestimation of AIDS in parts of Africa detracted from addressing the treatment of other infectious diseases in these countries.

It is always difficult to challenge data that has the imprimatur of a major international body tackling a horrendous international health crisis. But flawed data and noble lies do no one any favors. The Post did an admirable job in following the motives and the money behind the numbers – and it provided a model of the kind of analytic journalism we need more of.