Global Health


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And I'm Renee Montagne.

The government of India has released a new estimate of HIV infections that is dramatically lower than previous estimates. It had been thought that more than five million people in India were infected with HIV. The new estimate finds about half that amount. Similar results from surveys in other countries are raising questions about the reliability of the global estimates of HIV and AIDS.

NPR's Brenda Wilson reports.

BRENDA WILSON: With the India survey complete, there have now been surveys in 30 countries that significantly reduced the rate of HIV-AIDS. These particular surveys randomly select people to match the characteristics of the nation's entire population, by age, income, education, and where they live - in rural or urban areas.

Karen Stanecki, an adviser in the UNAIDS Epidemiology Unit says that the Indian survey reached people missed by other methods.

Ms. KAREN STANECKI (Senior Adviser, U.N. AIDS Epidemiology Unit): This gives us better estimate for men and a greater geographic region. Although that doesn't include necessarily those populations most at risk such as people who are involved in more riskier behavior, perhaps, the sex workers and injecting drug users, and there's a large proportion of homeless street people.

WILSON: Previous surveys focused almost entirely on high risk groups. They were designed almost 30 years ago to capture trends in the infection but they ended up being used to measure the extent of the epidemic. India's old data came from clinics where men were treated for sexually transmitted infections. They came from brothels, in clinics for pregnant women.

In Ethiopia, the data came from pregnant women at urban clinics. Povakel Vandasami(ph) coordinated Ethiopia's health survey.

Ms. POVAKEL DENDOSAMI (Health Survey Coordinator): HIV prevalence among the wealthy, the educated, and the urban is higher than among the rest of the population. So when you obtain a prevalence rate based on this select group of women and then try to estimate for the whole population based on this group, you are definitely going to get a higher prevalence rate.

WILSON: That system of tracking the AIDS epidemic where you were guaranteed to find it was devised in the mid-1980s by Dr. James Chen, a professor of epidemiology at the University of California, Berkeley.

Dr. JAMES CHEN (Professor, University of California, Berkeley): That system was not designed to make estimates of the total number of HIV infections in a population.

WILSON: Chen says UNAIDS officials should have adjusted global numbers when numbers in individual countries started dropping as new surveys were done.

Dr. CHEN: So that Ethiopia last year went from 1.9 million, estimate, down to half a million. I mean that's a significant reduction. All I'm saying is that they have been very, very reluctant to accept what I consider to be the more accurate method.

WILSON: UNAIDS' Karen Stanecki.

Ms. STANECKI: Number one, we have been downward adjusting our estimates, so that's not true that we are reluctant do so; we have done so in the past. And number two, we don't do this in isolation, we do this with our country colleagues.

WILSON: It's a negotiation. U.N. agencies can't just walk into a country and take surveys. They are invited in, often by local officials. So for example, when Ethiopia balked at having its estimate reduced, the U.N. was put in the position of reporting an estimate that have a huge range - from half a million to one and a half-million.

Chris Murray of the Health Metrics and Evaluation Institute says that's why measuring the size health problems should be kept as far as possible from the people who are running the health programs.

Dr. CHRIS MURRAY (Health Metric and Evaluation Institute): If your problem, HIV, malaria, TB, anything else, is bigger, you are likely to get more money, and people know this. So there is a dynamic that's out there that does inject all this measurement with a political dimension.

WILSON: At one point worldwide estimates for HIV were at 42 million. They are now down to around 39 million. And when India released its HIV estimates today, the numbers dropped even further.

Brenda Wilson, NPR News.

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