IV transmission has not spread in Asia beyond the highest HIV-risk groups, such as gay men, injecting drug users, and sex workers, into any general population. However, UNAIDS's perpetuation of the myth that everyone is at risk of AIDS has led to billions wasted on HIV prevention programs directed at general populations and especially youth, who, outside of sub-Saharan Africa, are at minimal risk of any exposure to HIV. UNAIDS's proposed budget for 2008 includes US$1.9 billion for prevention programs aimed at young people and the workplace. While some of this will be usefully spent in sub-Saharan Africa, the rest is effectively wasted.
At least US$5 billion has been wasted in this way in the last five years. Meanwhile, to the shame of the global health bureaucracy, a handful of diseases that are relatively inexpensive to prevent or treat -- several vaccine-preventable diseases, diarrheal diseases, malaria and some acute respiratory infections -- continue to account for about four million annual child deaths globally.
UNAIDS is apparently concerned that support for AIDS programs might be reduced if most regional HIV rates are stable or decreasing and HIV remains concentrated in the highest-risk populations.
These are realistic concerns but global and regional HIV rates have remained stable or have been decreasing during the past decade; HIV continues to be concentrated in populations with the highest levels of HIV risk behaviors; and HIV is incapable of epidemic spread in the vast majority of heterosexual populations.
Continued denial of these realities will further erode whatever credibility UNAIDS and other mainstream AIDS agencies and experts may still have, and will seriously damage the future fight against this disease: let's face the data and put the money where the real problems really are.
James Chin, a former chief of the surveillance, forecasting, and impact assessment unit of the Global Program on AIDS of the World Health Organization, is clinical professor of epidemiology at the School of Public Health, University of California at Berkeley. His monograph The Myth Of A "General" AIDS Pandemic is published by the Campaign for Fighting Diseases this month. He is in Geneva to meet policymakers at the WHA.
