Correction to This Article
An April 6 article and an accompanying graphic said the HIV rate among people in Botswana ages 15 to 49 was 34.9 percent. More recent information shows the rate to be 25.3 percent. The faulty statistic from the article was also used in an April 10 editorial.

How AIDS in Africa Was Overstated

Youths walk past an AIDS awareness billboard in Kigali, the capital of Rwanda, which has relied on approaches similar to those used successfully in neighboring Uganda to curb the spread of HIV, the virus that causes AIDS.
Youths walk past an AIDS awareness billboard in Kigali, the capital of Rwanda, which has relied on approaches similar to those used successfully in neighboring Uganda to curb the spread of HIV, the virus that causes AIDS. (Photos By Craig Timberg -- The Washington Post)

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By Craig Timberg
Washington Post Foreign Service
Thursday, April 6, 2006

KIGALI, Rwanda -- Researchers said nearly two decades ago that this tiny country was part of an AIDS Belt stretching across the midsection of Africa, a place so infected with a new, incurable disease that, in the hardest-hit places, one in three working-age adults were already doomed to die of it.

But AIDS deaths on the predicted scale never arrived here, government health officials say. A new national study illustrates why: The rate of HIV infection among Rwandans ages 15 to 49 is 3 percent, according to the study, enough to qualify as a major health problem but not nearly the national catastrophe once predicted.

The new data suggest the rate never reached the 30 percent estimated by some early researchers, nor the nearly 13 percent given by the United Nations in 1998.

The study and similar ones in 15 other countries have shed new light on the disease across Africa. Relying on the latest measurement tools, they portray an epidemic that is more female and more urban than previously believed, one that has begun to ebb in much of East Africa and has failed to take off as predicted in most of West Africa.

Yet the disease is devastating southern Africa, according to the data. It is in that region alone -- in countries including South Africa, Botswana, Swaziland and Zimbabwe -- that an AIDS Belt exists, the researchers say.

"What we know now more than ever is southern Africa is the absolute epicenter," said David Wilson, a senior AIDS analyst for the World Bank, speaking from Washington.

In the West African country of Ghana, for example, the overall infection rate for people ages 15 to 49 is 2.2 percent. But in Botswana, the national infection rate among the same age group is 34.9 percent. And in the city of Francistown, 45 percent of men and 69 percent of women ages 30 to 34 are infected with HIV, the virus that causes AIDS.

Most of the studies were conducted by ORC Macro, a research corporation based in Calverton, Md., and were funded by the U.S. Agency for International Development, other international donors and various national governments in the countries where the studies took place.

Taken together, they raise questions about monitoring by the U.N. AIDS agency, which for years overestimated the extent of HIV/AIDS in East and West Africa and, by a smaller margin, in southern Africa, according to independent researchers and U.N. officials.

"What we had before, we cannot trust it," said Agnes Binagwaho, a senior Rwandan health official.

Years of HIV overestimates, researchers say, flowed from the long-held assumption that the extent of infection among pregnant women who attended prenatal clinics provided a rough proxy for the rate among all working-age adults in a country. Working age was usually defined as 15 to 49. These rates also were among the only nationwide data available for many years, especially in Africa, where health tracking was generally rudimentary.

The new studies show, however, that these earlier estimates were skewed in favor of young, sexually active women in the urban areas that had prenatal clinics. Researchers now know that the HIV rate among these women tends to be higher than among the general population.


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© 2006 The Washington Post Company

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