From: MPetrelis@aol.com
Date: Sat, 29 Jul 2000 19:33:33 EDT
Subject: Vital Stats: AIDS reporting needs to be skeptical
Web link: Click
here: Death in the Shadowlands. VitalSTATS July 2000
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: vital@stats.org
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 -` 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 London-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 -Bangui definition,- 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 -prolonged fevers
(for a month or more), weight loss of 10 percent or greater, and prolonged
diarrhea.- 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 (-AIDS in Africa: An Epidemiologic
Paradigm-) observed, -while 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.-
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 -` 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 -promised that there would be -no limit- to the
funds available for combating AIDS in the developing world.-).
It would compound one assured (but still shadowy in scale) public health
tragedy if the world were to mobilize to -save-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
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www.AIDS-statistics.com
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San Francisco, CA 94114