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.
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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)

"It's pure advocacy, really," said Jim Chin, a former U.N. official who made some of the first global HIV prevalence estimates while working for WHO in the late 1980s and early 1990s. "Once you get a high number, it's really hard once the data comes in to say, 'Whoops! It's not 100,000. It's 60,000.' "

Chin, speaking from Stockton, Calif., added, "They keep cranking out numbers that, when I look at them, you can't defend them."

Ghys said he never sensed pressure to inflate HIV estimates. "I can't imagine why UNAIDS or WHO would want to do that," he said. "If we did that, it would just affect our credibility."

Ghys added that studies now show that the overall percentage of Africans with HIV has stabilized, though U.N. models still show increasing numbers of people with the virus because of burgeoning populations.

Many other researchers, including Wilson from the World Bank and two epidemiologists from the U.S. Agency for International Development who wrote a study published last week in the Lancet, a British medical journal, dispute that conclusion, saying that the number of new cases in Africa peaked several years ago.

Some involved in the fight against AIDS say that tallying HIV cases is not nearly as important as finding the resources to fight the disease. That is especially true now that antiretroviral drugs are more affordable, making it possible to extend millions of lives if enough money and health-care workers are available to facilitate treatment.

"It doesn't matter how long the line is if you never get to the end of it," said Francois Venter, a South African doctor and head of Johannesburg General Hospital's rapidly expanding antiretroviral drug program, speaking in an interview in Johannesburg.

But to the researchers who drive AIDS policy, differences in infection rates are not merely academic. They scour the world looking for evidence of interventions that have worked, such as the rigorous enforcement of condom use at brothels in Thailand and aggressive public campaigns that have urged Ugandans to limit their sexual partners to one.

Programs deemed successful are urged on other countries and funded lavishly by international donors, often to the exclusion of other programs.

Rwanda, a mountainous country of about 8.5 million people jammed into a land area smaller than Maryland, has relied on approaches similar to those used in Uganda, and may have produced similar declines in HIV. UNAIDS estimated in 1998 that 370,000 Rwandans were infected, equal to 12.75 percent of all working-age adults and a substantial percentage of children as well. Every two years since, the agency has lowered that estimate -- to 11.2 percent in 2000, 8.9 percent in 2002 and 5.1 percent in 2004.

Dirk van Hove, the top UNAIDS official in Rwanda, said the next official estimate, due in May, would show an infection rate of "about 3 percent," in line with the new national study. He said the U.N. estimate tracked the declining prevalence.

Rwandan health officials say their national HIV infection rate might once have topped 3 percent and then declined. But it's just as likely, they say, that these apparent trends reflected nothing more than flawed studies.

Even so, Rwanda's cities show signs of a serious AIDS problem not yet tamed. The new study found that 8.6 percent of urban, working-age women have HIV. Overall, officials say, 150,000 Rwandans are infected, less than half the number estimated by UNAIDS in 1998.

Bruno Ngirabatware, a physician who has treated AIDS patients in Kigali since the 1980s, said he has seen no evidence of a recent decline in HIV infection rates.

"There's lots of patients there, always," he said.


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