Myths behind AIDS might lead to billions in misspending

Raising money is the easy part. Spending it effectively is harder.

Good managers know that good policy cannot exist without accurate data but UNAIDS has systematically exaggerated the size and trend of the pandemic, in addition to hyping the potential for HIV epidemics in "general" populations. While this distortion of HIV epidemiology has been useful for raising money, it has resulted in billions of dollars of unnecessary and misdirected spending.

Part of UNAIDS's fundraising success has been its ability to convince donors that the pandemic is getting worse and is also a potential threat to all people everywhere. But UNAIDS's claims are not supported by the epidemiologic data.

This data tells us that those at greatest risk of HIV infection are: heterosexuals and gay men who have unprotected sex with concurrent and multiple partners, within open or overlapping sex networks; regular sex partners of HIV infected persons; and people exposed to HIV infected blood, such as injecting drug users.

In framing the global response to AIDS, UNAIDS has ignored this and promoted a range of myths that have more to do with political correctness than science.

For instance, UNAIDS claims that poverty and discrimination are major determinants of high HIV prevalence. In 1987, John Mann, the first head of AIDS at the World Health Organization, claimed that being "excluded from the mainstream of society or being discriminated on grounds of race, religion or sexual preference, led to an increase of HIV infection," a litany uncritically accepted by UNAIDS.

All available data suggests the opposite. In Africa, AIDS is a disease associated with wealth. The richest people in Kenya, Tanzania and Ethiopia have HIV rates several times higher than the poorest, probably because wealthy men and women in these countries have more sex partners.

Poverty and discrimination present barriers to gaining access to prevention and treatment but are not primary determinants of sexual behavior -- the real determinant of sexual HIV transmission. The U.S. response to global AIDS -- US$50 billion over the next five years (held up in the Senate but likely to pass) -- is based on the poverty principle. This mistake could lead to all kinds of mis-spending down the line.

In a similar vein, UNAIDS has consistently claimed that the world is on the brink of generalized heterosexual HIV epidemics. In 1997, UNAIDS chief Peter Piot gloomily foretold that "AIDS will cut through Asian populations like a hot knife through cold butter." Aside from a few explosive heterosexual epidemics within large commercial sex networks in Thailand, Myanmar, Cambodia and several states in India in the late 1980s to early 1990s, Dr. Piot's dire and colorful prediction never occurred.