New African HIV infection rate estimates

New research is suggesting that UN estimates of HIV infection rates in parts of Africa may have been high. 

The new research also indicates that AIDS remains a very serious public health problem in much of Africa, and Southern Africa remains an HIV/AIDS disaster. 

Craig Timberg reports in the Washington Post: How AIDS in Africa Was Overstated. Reliance on Data From Urban Prenatal Clinics Skewed Early Projections (April 6)

UNAID agency estimates of HIV infection rates in East and West Africa have been very high:

A new national study illustrates why  [That is, why AIDs deaths didn't reach projected levels in Rwanda - Ben] . The rate of HIV infection among Rwandans ages 15 to 49 is 3 percent, according to the study, enough to qualify as a major health problem but not nearly the national catastrophe once predicted.

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.

The study and similar ones in 15 other countries have shed new light on the disease across Africa. Relying on the latest measurement tools, they portray an epidemic that is more female and more urban than previously believed, one that has begun to ebb in much of East Africa and has failed to take off as predicted in most of West Africa.

Unfortunately, rates in Southern Africa weren't overestimated as much:

Yet the disease is devastating southern Africa, according to the data. It is in that region alone -- in countries including South Africa, Botswana, Swaziland and Zimbabwe -- that an AIDS Belt exists, the researchers say.

"What we know now more than ever is southern Africa is the absolute epicenter," said David Wilson, a senior AIDS analyst for the World Bank, speaking from Washington.

In the West African country of Ghana, for example, the overall infection rate for people ages 15 to 49 is 2.2 percent. But in Botswana, the national infection rate among the same age group is 34.9 percent. And in the city of Francistown, 45 percent of men and 69 percent of women ages 30 to 34 are infected with HIV, the virus that causes AIDS.

What caused the miscalculation?

Years of HIV overestimates, researchers say, 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. Working age was usually defined as 15 to 49. These rates also were among the only nationwide data available for many years, especially in Africa, where health tracking was generally rudimentary.

The new studies show, however, that these earlier estimates were skewed in favor of young, sexually active women in the urban areas that had prenatal clinics. Researchers now know that the HIV rate among these women tends to be higher than among the general population.

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.

Are there deeper reasons for the miscalculation.  The "culprit" in this article is UNAIDS - the UN's AIDS agency:

"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."...

On its Web site, UNAIDS describes itself as "the chief advocate for worldwide action against AIDS." And 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.

In fairness, the article quotes a UNAID insider who says he never felt pressure to inflate numbers.

The article only hints at the consequences:

Such disparities, independent researchers say, skewed years of policy judgments and decisions on where to spend precious health-care dollars....

But to the researchers who drive AIDS policy, differences in infection rates are not merely academic. They scour the world looking for evidence of interventions that have worked, such as the rigorous enforcement of condom use at brothels in Thailand and aggressive public campaigns that have urged Ugandans to limit their sexual partners to one.

Programs deemed successful are urged on other countries and funded lavishly by international donors, often to the exclusion of other programs.

There's not a lot of discussion - beyond the above - of the potential impacts of the misleading estimates on AIDS interventions.

Thanks to Tyler Cowen and Daniel Drezner for the tip.

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