allAfrica.com: Africa: Despite New Figures, Aids Funding Doesn't Meet Needs

Excerpt from a speech by Stephen Lewis, Co-Director, AIDS-Free World to the World Health Editors Network, Imperial College, London, UK Friday, November 23, 2007, 11:00 am.

It's fair to say that any speech designed to address leadership and AIDS must start with the events of this week: the publication of the UNAIDS Epidemic Update, 2007.

Let me get two matters out of the way at the outset. I think the new set of numbers is much closer to the truth of the pandemic, although I'm inclined to believe that they're still too high and that another awkward revision lies ahead. Second, I don't believe for a moment that UNAIDS inflated the figures for the purpose of extracting money. That seems to me too conspiratorial by half. If by some bizarre happenstance, Machiavelli's apprentices were involved, they make lousy fund-raisers: we're billions of dollars short of where we should be, old estimates or new.

I take issue with the report on different grounds. For years, knowledgeable epidemiologists have been telling the UN that the figures were too high. They didn't whisper their criticisms: they wrote books and articles. They lobbied behind the scenes. No one paid them heed. It doesn't take a Nobel prize statistician to guess that prevalence rates based on urban antenatal clinics should not be extrapolated to the entire country and presented as holy writ. That became compellingly clear when the spate of population-based household surveys, country after country, invariably showed lower prevalence.

But the UN chose a course of delay and dithering. It can never admit that it's wrong. So finally, and predictably, came the moment of truth: the result is an overall prevalence rate that is lower by almost seven million than last year's estimate.

Sure, it can be rationalized by arguing that it's just a methodological adjustment, rooted in superior statistical-gathering techniques. And that might even be persuasive if there hadn't been academicians and epidemiologists clamouring for revision for years. The UNAIDS explanation sounds good; the fine print has the ring of arcane scientific authority. But down here, in the mortal universe, where people aren't easily taken in, it doesn't wash.

The UN was stubborn and it was sloppy. In the process, it undermined public confidence in the reliability of the figures, introducing completely unnecessary levels of doubt, contention and confusion.

Where HIV/AIDS is concerned, there is no room for the jolting of confidence. The new estimates confirm a continuing apocalypse for sub-Saharan Africa: 22.5 million infections, 61% of them women, 68% of world-wide infections, 76% of all deaths, 11.4 million orphans … this is where the focus must be, this is where it should always have been; not a report cluttered by mathematical adjustments so that virtually every story that's written begins with the news of a statistical volte-face. If the recording of data had been more scrupulous all along, we could have welcomed this report as the latest instalment in a record of declining numbers, showing some strong hints of progress, and plausibly leading to universal access for treatment, prevention and care by 2010.

Instead, all of us have to run to the trenches to remind the world that more money is still desperately needed and that the situation, in many places, remains grim, bleak, funereal.

As a matter of fact, at the risk of knocking the nail through the wall, allow me to add that I earlier used the word 'sloppy' advisedly. For a number of years in the 1990's, I was the Deputy at UNICEF and oversaw a raft of publications. I would never have permitted this Update to go out as is.

Let me explain by way of example.

In one of the dense explanatory notes, there's a statistical adjustment described that attracted little notice, but seems to me to be of enormous import. If I may attempt a straightforward simplification, the report seems to be saying that, on average, the population-based random household surveys in countries with generalized HIV epidemics produced estimates that were 20% lower than the estimates produced by antenatal surveys. Therefore, says the report, for all those countries with generalized epidemics that have not yet done random surveys, we're applying a reduction factor of .8 … that is to say, the new figures will be 80 % of the old figures.

That's quite a reduction! Don't you think it might have been useful to produce a table (there were, after all, tables galore) to show what it might mean, in practice, country by affected country? No such luck.

Instead, the report notes that "Of the total difference in the estimates published in 2006 and 2007, 70% are due to changes in six countries: Angola, India, Kenya, Mozambique, Nigeria and Zimbabwe." I was stumped by Angola because its prevalence rate is so low, it's hard to imagine that it could make a great difference to the numbers. India everyone knows about. Kenya and Zimbabwe have oft been talked about (although the alleged decline in Zimbabwe seems to me to be complicated by the numbers of deaths, the out-migration, and the difficulty of reliable surveys in a sociological wasteland). Nigeria was clearly possible. But Mozambique was a mystery because I remembered from my last visit that the most recent data had shown an increase in prevalence.

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