Subject: Vital Stats: AIDS reporting needs to be skeptical
From: [email-masked]
Date: Sat, 29 Jul 2000 19:33:33 EDT

Web link: <A HREF="http://www.stats.org/newsletters/0007/africa.htm">Click 
here: Death in the Shadowlands. VitalSTATS July 2000</A> 

http://www.stats.org/newsletters/0007/africa.htm

Vital Stats, The Numbers Behind The News
July 2000

Statistical Assessment Service
2100 L Street, NW, Suite 300
Washington, DC 20037
P: 202-223-3193
E: [email-masked]

Death in the Shadowlands

Another crisis whose urgency may depend as much upon definitions as disease 
is AIDS in Africa. The topic has generated intense media exposure, with over 
350 Nexis citations on that topic during June and early July alone. 

The coverage has been extensive, focused on State Department and White House 
announcements, national security considerations, and the sheer human tragedy. 
There have been news weekly cover stories, in-depth portrayals on network TV, 
numerous sober editorials, and more feature articles in major dailies than 
one could possibly read (over 165 citations in the nine days between July 1 
and July 10) which all have hammered home the stunning news â-` Africa is going 
up in sexual flames. 

Fewer than half of one percent of North Americans and Europeans are HIV 
positive. However, in parts of southern Africa, such as Botswana, as many as 
35 percent of the population is said by Londonâ-™s Daily Telegraph (Jul. 10) to 
be HIV positive. (Reuters, however, places the figure at 29%, while the July 
7 Science, using official figures from the South African government, offers 
23%). 

But what has not received media attention is a troubling realization. Based 
on standard medical practice, we actually have no idea how widespread the 
disease is in Africa. 

There are two related problems -- the reliability of HIV prevalence 
estimates, often nationwide extrapolations from selected sites, and the 
accuracy of a full-blown AIDS diagnosis. Not only are public health figures 
in several African regions dubious in general (as are nearly all government 
data in these areas), practically every commentator speaking out on the 
African holocaust neglects to mention what may well be the heart of the 
matter: The criteria for declaring an AIDS case in Africa do not include an 
actual blood test to determine whether or not the patient is HIV positive. 

According to what is known as the â-œBangui definition,â-� named for the city in 
the Central African Republic where it was adopted in 1985, a diagnosis of 
AIDS could be given in the presence of features such as â-œprolonged fevers 
(for a month or more), weight loss of 10 percent or greater, and prolonged 
diarrhea.â-� But no blood test is required. That is, deaths that heretofore 
were attributed to malaria, dysentery, or tuberculosis, for instance, may now 
be classified and accounted as AIDS deaths. (In fact, the June 23 Science 
reports that one study found TB in 40% of HIV-infected people upon autopsy). 

As a November, 1986 article in Science (â-œAIDS in Africa: An Epidemiologic 
Paradigmâ-�) observed, â-œwhile pediatric HIV disease in Africa resembles HIV 
infections in children in the United States, it is difficult to distinguish 
HIV-associated disease in Africa on clinical grounds, where failure to 
thrive, malnutrition, and pulmonary disease are common pediatric problems.â-�

Hence, while estimates of the extent of HIV infection have been forthcoming 
(ideally based on blood analysis), the true scope of the crisis is simply 
unknown. There could be vastly more cases lurking than have been dreamed of 
in the current nightmare â-` or there could be substantially less. 

A medically precise definition of an African AIDS case, though difficult to 
obtain, is an essential tool in fighting the disease, particularly when it 
comes to directing resources (According to the April 27 Nature, World Bank 
President James Wolfensohn â-œpromised that there would be â-˜no limitâ-™ to the 
funds available for combating AIDS in the developing world.â-�). 

It would compound one assured (but still shadowy in scale) public health 
tragedy if the world were to mobilize to â-œsaveâ-�Africa -- only to find that 
it had sent condoms and the AIDS drug AZT, when what was most needed on the 
docks in Maputo and Luanda were clean water and antibiotics. 

Proper reportorial skepticism and careful medical accounting have never been 
more in need.

========================

Michael Petrelis
 <A HREF="http://www.aids-statistics.com/">Welcome to AIDS-STATISTICS</A>
www.AIDS-statistics.com 
2215-R Market Street, #413
San Francisco, CA 94114