MYTHS AND MISCONCEPTIONS OF THE AIDS PANDEMIC

Many myths and misconceptions about the AIDS pandemic are spread by
the Joint United Nations Program on HIV/AIDS (UNAIDS) and other
mainstream AIDS agencies and activists, either unintentionally out of
ignorance or intentionally by distortion or exaggeration, including
fear of a generalized epidemic.

UNAIDS continues to perpetuate the fallacy that only aggressive
HIV/AIDS prevention programs -- especially directed at youth -- can
prevent the eruption of heterosexual HIV epidemics where prevalence
is currently low. More than two decades of observation and analysis
point to far different conclusions -- there are no "next waves" of
HIV epidemics just around the corner and the AIDS pandemic is now in
its post-epidemic phase.

The highest HIV infection rates are found in many sub-Saharan African
populations because up to 40 percent of adolescent and adult males
and females in these populations routinely have multiple and
concurrent sex partners, and they also have the highest prevalence of
factors that can greatly facilitate sexual HIV transmission. In most
other heterosexual populations, the patterns and frequency of
sex-partner exchanges are not sufficient to sustain epidemic sexual
HIV transmission.

UNAIDS and most AIDS activists reject this analysis as socially and
politically incorrect, saying it further stigmatizes groups, such as
injecting drug users, sex workers and men who have sex with men.
However, all available epidemiologic data show that only the highest
risk sexual behavior (multiple, concurrent and a high frequency of
changing partners) drives HIV epidemics among heterosexuals or men
who have sex with men, anywhere in the world.

Most AIDS activists claim, without any supporting data, that high HIV
prevalence in groups of men who have sex with men or injecting drug
users will inevitably "bridge" over to the rest of the population and
lead to "generalized" HIV epidemics. This entrenched myth persists
even though there is little, if any, HIV spread into any "general"
population except from infected injecting drug users and man who have
sex with men or bisexuals to their regular sex partners.

Without a constant flow of alarming news releases warning about HIV
being on the brink of spreading into general populations, AIDS
activists fear that the public and policymakers will not continue to
give AIDS programs the highest priority -- hence these "glorious
myths," lies told for a noble cause.

This alarmism goes against all the evidence. Global and regional HIV
rates have remained stable or have been decreasing during the past
decade (except possibly among drug users in Eastern Europe). HIV has
remained concentrated in groups with the riskiest behavior. Several
decades of experience support the conclusion that HIV is incapable of
epidemic spread among the vast majority of heterosexuals.

Most of the public, policymakers and media have no inkling that the
UNAIDS working assumption is inconsistent with established facts --
indeed, until 2006, no major public health or international
development agency had openly challenged this assumption.

Some cracks in this wall of silence began to appear during 2006 with
the publication of several studies which questioned the UNAIDS view.

Since 2000, dozens of population-based HIV sero-surveys have forced
UNAIDS to reduce its overestimates in most high-HIV-prevalence
countries by around 50 percent or more: examples include Kenya's
estimate in 2001 of 14 percent reduced to 6.7 percent and Haiti's
2001 estimate of 6.1 percent reduced to 2.2 percent in 2006.

Estimates of HIV prevalence in China has been decreasing rather than
increasing and the estimate now of more than 5 million HIV infections
in India is likely to be cut by half or more as the result of recent,
and more accurate, studies.

In 2007, UNAIDS needs to come up with more realistic HIV estimates
and projections, especially when more mainstream epidemiologists and
the news media begin to question the basis of the UNAIDS assumption.

Continued denial of these realities will lead to further erosion of
the credibility of UNAIDS and other mainstream AIDS agencies, raising
the danger of people underestimating the real threats.

Regardless of my epidemiologic disagreements with UNAIDS, I totally
agree with mainstream AIDS experts, who declare that this is no time
to be complacent about strengthening HIV treatment and, above all,
HIV prevention programs.

Although many countries have overestimated their numbers, there are
now at least 20 million HIV-infected people in sub-Saharan Africa and
several million in Asia and these numbers can be expected to remain
close to these levels for a decade or more.

AIDS is a severe problem in sub-Saharan Africa and to a lesser extent
in Caribbean countries and a few Southeast Asian countries, as well
as among men who have sex with men, injecting drug users and sex
workers throughout the world.

This means that scarce health resources in countries with low HIV
prevalence should be targeted primarily at those who are at the
highest HIV risk, instead of being misdirected to the wider public.

We must cut through the overestimates of HIV prevalence and the
exaggerated potential for generalized HIV epidemics so we can
concentrate money and efforts on prevention and palliative care where
it really matters.

James Chin, a professor of epidemiology at UC Berkeley, is a former
chief of the surveillance, forecasting and impact Assessment unit of
the Global Program on AIDS of the World Health Organization. He is
the author of "The AIDS Pandemic: the collision of epidemiology with
political correctness" (Radcliffe, Oxford, 2007).