A STAGGERING 40 million people are now infected with HIV, 2.5 million of them children. But amid the grim statistics there are signs that maybe, just maybe, the tide is beginning to turn. Antiviral drugs are at last getting cheaper and money is beginning to flow from western governments and foundations in the quantity needed to give people access to the drugs.
These are grounds for congratulating the World Health Organization and UNAIDS, the United Nations agency that monitors the disease. Yet treating infected people is only one front in this war: the second, no less vital campaign is to prevent new infections. And here the policies of officials are beginning to look not only less convincing but possibly dangerously self-serving (see 鈥淲HO accused of huge HIV blunder鈥�).
At issue is the degree to which dirty needles are responsible for spreading infection in the developing world. A handful of dissenting epidemiologists have been arguing for some time that unsafe injections are responsible for 30 per cent or more of new HIV infections in sub-Saharan Africa. The WHO insists a mere 2.5 per cent occur this way. The debate matters because up to now the money spent preventing unsafe injections in poor countries has been invisible compared with the amounts poured into campaigns to foster safer sex.
Advertisement
So who鈥檚 right? The dissenters鈥� methods involve comparing groups of infected and non-infected people on a range of health and lifestyle factors, and using the results to calculate the proportion of infections that are likely to be due to unsafe injections versus, say, unsafe sex. Scaling these risk estimates across the population as a whole is inappropriate, claims the WHO. Yet its objections appear more technical than fundamental, and the calculations underpinning the WHO鈥檚 own 2.5 per cent figure looks no more watertight. They are based on researchers visiting clinics and counting any unsafe injections. These figures are then scaled up for the whole region and multiplied by the theoretical risk of any single unclean injection transmitting HIV. The problem is that the visiting scientists do not go incognito and clinics will understandably be keen to make a good impression.
It is tempting to conclude that both sides are equally at fault for stubbornly exaggerating their case. But this would be wrong. There is a legitimate place in science for dissenters to don blinkers and push heretical findings hard in the face of establishment opposition.
UN organisations have no such excuse. They are supposed to look at the big picture, and deliver a balanced verdict. That they appear unwilling to admit that unsafe injections might be more of problem than they once thought is deeply troubling. It will inevitably fuel suspicions that they are downplaying the problem to protect the reputation of their health officials鈥� immunisation campaigns, and to keep blame from their own doorsteps.