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WHO Accused of Huge HIV Blunder
      #111473 - 09/09/04 07:12 PM





WHO Accused of Huge HIV Blunder


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The positive HIV test was a surprise. The boy let's call him Sipho - never
had a blood transfusion. He did not inject drugs or have unprotected sex.
He died when he was just seven months old, yet another South African
victim of AIDS.

The natural assumption was that he must have picked up the disease from
his mother in the womb, but her HIV test came back negative. So where did
Sipho catch the virus? No one can be sure, but it is most likely that he
was infected in hospital, perhaps by a needle that had not been sterilised
after being used on an infected patient.

The World Health Organization thinks that tragedies like Sipho's are very
much the exception. It estimates that unsafe injections during healthcare
account for just 2.5 per cent of HIV cases in Africa, and that the vast
majority of infections are via sex.


HIV: The scale of the epidemic
But some researchers believe the role of dirty needles has been greatly
underestimated. If they are right, relatively simple measures could save
millions of people worldwide.

This week, the group Physicians for Human Rights based in Washington DC
sent an open letter to the WHO and UNAIDS. It calls for more resources to
be spent on preventing infection by dirty needles. The letter says people
should be educated about the dangers, and measures taken such as providing
syringes that cannot be used more than once.


'Firestorm of protest'


But the WHO and UNAIDS have long resisted the suggestion that injections
are an important driver of the epidemic. "It has been a huge struggle to
make the case that this is a significant part of the epidemic," says
Ernest Drucker, an AIDS expert at Yeshiva University in New York. "We've
run into a firestorm of protest."

"The worry is that if too much attention is paid to unsafe injections it
will take away from the message about sexual transmission," says James
Whitworth at the London School of Hygiene and Tropical Medicine, who backs
the WHO position. Another fear is that vaccination programmes will be
undermined if injections are seen as risky.

While these concerns might be valid, critics argue the consequences of
downplaying the role of dirty needles are far worse. The most vociferous
of them is David Gisselquist, an independent researcher in Hershey,
Pennsylvania, who has published a string of papers highlighting dirty
needles as a major risk factor (New Scientist print edition, 1 March
2003).

Using the WHO's own estimate that 7.6 per cent of infections in 1988 were
from dirty needles or blood transfusions, he says healthcare is to blame
for 10 million infected people today. If needles cause closer to half of
all infections, as Gisselquist believes, tackling the problem would have
kept the epidemic confined to high-risk groups, he claims.

"In Asia, if we don't get that message out, the epidemic could really blow
up," he warns. The WHO's own figures, based on observations in hospitals
and clinics, suggest that up to 75 per cent of injections in parts of
south-east Asia are carried out using unsterilised equipment, compared
with just 20 per cent in sub-Saharan Africa.


Unpublished report


Gisselquist's work prompted the WHO to hold a meeting on unsafe injections
in March 2003. He says data supporting his claims was presented, but it
was not reflected in the meeting's conclusions. Instead, the press release
proclaimed: "An expert group has reaffirmed that unsafe sexual practices
are responsible for the vast majority of HIV infections in sub-Saharan
Africa."

Six months before the meeting, UNAIDS drew up a report, which has been
seen by New Scientist, that contradicts this position. Based on a review
of 23 studies, it concludes that in sub-Saharan Africa, "contaminated
injections may cause between 12 and 33 per cent of new HIV infections".
That is far higher than the accepted 2.5 per cent figure.

That report has never been published, prompting Gisselquist to accuse the
WHO of ignoring evidence that does not support its views. But according to
Peter Ghys of UNAIDS in Geneva, the document was a preliminary draft that
has since been incorporated into a much larger summary of the evidence.
That study, due to be published early next year, will support the WHO
estimate of about 2.5 per cent.

George Schmid, a senior researcher on HIV at the WHO in Geneva and author
of the revised study, says the apparent change of view arises because a
statistical technique used in the 2002 draft is inappropriate for HIV.

The reviewed studies calculate a "population attributable fraction", the
proportion of infections in the population due to a specific risk factor.
Schmid says this method works for non-infectious diseases, but not when
infected people can affect the future course of the disease by infecting
other people.


Second birthday


Gisselquist's critics also ask why hepatitis C, which is mainly spread by
needles, does not mirror the pattern of HIV infection, and why HIV has
spread in some countries with relatively good healthcare.

In response, Gisselquist claims hundreds of studies have reported
significant numbers of children who, like Sipho, have contracted the
disease despite having HIV-negative parents or parents with a different
HIV strain.

A study of nearly 10,000 South Africans released in 2002, for instance,
found that 5.6 per cent of children aged between 2 and 14 were infected.
Most children infected by their mothers die before their second birthday,
so the surprisingly high figure points to infection routes other than sex
being important.

But Schmid says the results of all these studies are questionable. For
instance, the instrument used to collect samples in the South African
study was not approved by the FDA for use on children, he says. Schmid is
now helping to design a follow-up study.

Whatever its results, there is little likelihood of the argument being
resolved. Drucker claims that the longer WHO and UNAIDS deny a major role
for injections, the harder it is becoming for them to climb down. The real
tragedy, he says, is that injection safety is an easy win compared with
trying to promote safe sex. "Clearing up the medical care system is not
such a major task."


James Randerson


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MORE MISLEADING STATS FROM UNAIDS
Rodney Richards, Ph.D. July 12, 2002

In an earlier article I summarized data from recent scientific
publications in order to demonstrate that: “Median time from
seroconversion to AIDS and death in poor, starving rural Africans (without
access to health care, purified water or electricity) living in the Masaka
District of Uganda (where malaria, dysentery and measles are endemic) is
no different than that observed in Europeans, North Americans, or
Australians who have full access to proper nutrition, health-care,
‘life-prolonging’ antiretrovirals, and prophylaxis against
opportunistic infections!” (Richards RM. New study shows AIDS drugs
equally effective as poverty and malnutrition. March 2002.)

However, new data in a recently released 2002 UNAIDS report appears to
contradict this conclusion. Specifically, according to a UNAIDS press
release, “In high-income countries, where an estimated 500,000 are
receiving antiretroviral treatment, 25,000 people died of AIDS in 2001.
In Africa, however, where only some 30,000 of the 28.5 million people
infected were receiving antiretroviral treatment, 2.2 million died of
AIDS.” (UNAIDS. New York, 2 July 2002.)

In other words, nearly 90 times as many Africans died of AIDS in 2001 as
compared to those in “high-income” countries, where
antiretroviral therapy (ART) is almost universally available. On the
surface, common sense would suggest this represents powerful evidence that
antiretroviral drugs must certainly be responsible for dramatically
improving survival. However, lets consider the following statement, which
is also based on statistics in the new 2002 UNAIDS report:

“In high-income countries, where 500,000 are receiving
antiretroviral drugs, 25,000 people died of AIDS in 2001. In Gambia,
however, where virtually no one is consuming these drugs, only 400 died of
AIDS.”

In other words, nearly 63 times as many people in high-income countries
died of AIDS in 2001 as compared to untreated Gambians. Isn't this strong
evidence that ART is responsible for dramatically decreasing survival? In
this case, our common sense now tells us there is a problem with such a
conclusion. If we are going to draw comparisons between these two
populations, perhaps it would be better to look at the death rates (i.e.,
AIDS deaths/number infected), rather than just the absolute numbers.

For example, according to the UNAIDS Report; only 8,400 Gambians were
living with HIV/AIDS at the end of 2001, as compared to 1,500,000 in the
rich countries. Therefore, 4.8% (400/8,400) of infected Gambians died of
AIDS in 2001 as compared to only 1.7% (25,000/1,500,000) of those infected
in rich countries. Now we see that infected Gambians are actually dying
2.8 times faster than those living in rich countries. Isn't this a more
realistic way to compare data? If we go through the same exercise with
all of Sub-Saharan Africa, we find that 7.7% of the estimated 28.5 million
infected there died of AIDS in 2001. This still represents a death rate
that is 4.5 times higher than observed in the high-income countries;
however, it is not even close to the 90-fold difference suggested by the
“raw data” in the above quote. Nonetheless, doesn't this
prove ART is improving survival by nearly 5 fold?

Not so fast! Lets move on to China. In 1997, UNAIDS announced that
400,000 Chinese were infected with HIV, yet only 1% (4,000) died of AIDS.
In contrast, 2.5% of infected Americans died in the same year, and this
was two years after the introduction of protease inhibitor containing
“highly active antiretroviral therapy” (HAART). Since the
government of China had only identified a cumulative total of 281 AIDS
cases by the end of 1997, we can presume at least 399,719 of these
infected Chinese were not receiving any ART, let alone HAART. Are we
therefore to conclude that HAART reduces survival by 2.5-fold as compared
to no drugs at all? Also in the same year, just a few hundred miles away
in wealthy Japan, where ART was freely available and HAART was rapidly
being introduced, 3.8% of those infected died of AIDS. Why are these
medicated Japanese dying nearly 4-times faster than their untreated
counterparts across the Sea of Japan?

In fact, just two years earlier in 1995, 5.1% of all infected Americans
died of AIDS in-spite of the universal availability of six FDA approved
antiretroviral drugs. Interestingly, drug free Nigerians are actually
doing slightly better than this today; according to the new UNAIDS report,
only 4.9% of the 3.5 million infected Nigerians died of AIDS in 2001.
Does this data prove that none of the drugs consumed by the 513,486
American AIDS patients through the end of 1995 were of any value? In
striking contrast to Nigeria, if we move on to Uganda, which has been
praised for its early and aggressive introduction of ART, we see that 14%
of their 600,000 infected citizens died of AIDS in 2001. This is nearly 3
times the rate observed in Nigeria, yet the government of Nigeria is just
now gearing up to launch a pilot program for the limited distribution of
antiretrovirals. Should we use this data to prove ART is killing people
in Uganda?

As we can see, for every comparison suggesting a benefit to therapy, we
can find another suggesting a detriment. There is a good scientific
explanation for this. In studies that measure disease progression in
persons with known dates of seroconversion, there is a clear correlation
between death rate and duration of infection. For example, persons who
have been infected for 12 years die, on average, 50 times faster than
those who have been infected for only 1 year. (Lancet 2000; 355:1131-7.)
Therefore, if we compare two populations, one where the majority has been
recently infected, and another where the majority has been infected for
quite some time; the latter population will experience a much higher
overall death rate. For this reason, even if the latter population was
receiving life-prolonging medications, they still may die, on average,
faster than the former population. This would serve to mask any
therapeutic effect. Likewise, even if the former population (recently
infected) was receiving medications that were killing them, they still may
die, on average, slower than the latter population. This would serve to
mask any toxic effect. Unfortunately, simply measuring the number of
persons testing positive in a given population can tell us nothing about
how long they have been infected.

For this reason, if we want to compare two populations, we must do so
using persons with known dates of seroconversion. When we do this,
starving HIV positive rural Ugandans without access to any antiretrovirals
survive just as long as their infected counterparts in the West who have
full access to ART. To date, there is no study using persons with known
dates of seroconversion after 1996 to show that survival is any better now
in the HAART era. However, as illustrated above, we certainly cannot rely
on death rates in various populations (with no knowledge of duration of
infection) to draw any conclusions in this regard. However, there is an
even more important reason why we should not try to draw any conclusions
from comparisons based on data presented by UNAIDS.

It is a little known fact that nearly all of the “HIV
infections” reported by UNAIDS, at least for the developing world,
are theoretical. Less than one-in a-thousand of the 28.5 million humans
infected in Sub-Saharan Africa have actually been tested for HIV. For
example, the declaration of 5 million infected South Africans is based on
projections from slightly more than 4,000 actual positive test results
using blood from pregnant women attending antenatal clinics, which are
scattered throughout the country. Furthermore, even these few test
results are obtained using a single ELISA test, which is known to produce
false positive results for a variety of reasons; including infections with
malaria and TB, which are endemic to much of Sub-Saharan Africa. And
finally, according to the manufacturer of the test they use, even for
person with true positive test results, “the risk
of…developing AIDS or an AIDS-related condition is not known.”
Regardless, UNAIDS then takes these 5 million hypothetically infected
individuals and plugs them into various computer models, which are tuned
to spit out virtual deaths and new infections at will. Unfortunately,
these numbers are then presented to the public as if they had something to
do with reality! However, as is the case with “HIV
infections,” the vast majority of “AIDS deaths” reported
by UNAIDS have also never been actually observed.

For example, UNAIDS has currently declared 24.8 million cumulative
“AIDS deaths” on this planet. However, according to the World
Health Organization (WHO), a total of only 2.8 million cumulative
worldwide AIDS cases have ever been observed. (WHO. WER 2001; 76: 381-8.)
If we exclude the 1 million AIDS cases and the 0.8 million AIDS deaths
that come from United States and Western Europe, we are left with only 1.8
million actual AIDS cases to account for the remaining 24 million
theoretical AIDS deaths. Furthermore, an unknown percentage of these 1.8
million AIDS cases are based on diagnoses without any HIV test results
whatsoever. This is because the “Bangui” definition of AIDS,
invented by the WHO in 1986, allows for a diagnosis of AIDS in the absence
of any test result if various combinations of persistent cough, diarrhea,
weight loss, and fever are present. Nevertheless, even if we were to
assume every one of these reported AIDS cases were truly infected, and
that they had already died; we still can account for only 7.5% of the
total theoretical AIDS deaths on this planet outside of the borders of the
United States and Western Europe. In contrast, even though the United
States and Western Europe account for only slightly more than 3% of the
worlds total AIDS deaths, 100% of the bodies have been found. The
percentage of AIDS deaths that can be accounted for drops even further as
we move into the developing world.

According to UNAIDS, more than 2,200,000 Ugandans have died from AIDS.
This represents more AIDS deaths than for any other country on the planet,
and corresponds to nearly 20% of its current adult population. To date,
however, the government of Uganda has only found about 56,000 citizens who
have ever even been diagnosed with AIDS (with or without an HIV test).
That’s less than 3% of the theoretical AIDS deaths! And this is
with the help of tens-of-millions of dollars flowing into the country from
the United Kingdom for HIV testing and surveillance purposes. Other
countries in Sub-Saharan Africa have experienced equal difficulty in
finding their hypothetical dead, ranging from only 1% in South Africa to a
record high of 10% in The Democratic Republic of the Congo. Some argue
that the discrepancy between UNAIDS figures and observed AIDS cases is due
to a lack of surveillance resources in developing countries. However,
this inconsistency persists even as we move into the so-called
“middle-income” countries with dramatically superior medical
infrastructures.

For instance, the Russian Federation can account for only 3% of its
conjectured AIDS corpses, India has only found 2% of its allocated 1.5
million dead, and China is still missing 99% of its declared 87,400 dead
AIDS patients! So who are we to believe; the governments of these
countries who have dedicated tens-of-millions of dollars into finding real
bodies, or the computer geeks at the WHO in Geneva? Perhaps the answer
lies somewhere in-between; however, officials who dare to question the
astronomical numbers produced by the UNAIDS/WHO computer games are
publicly vilified and even accused of murder.

In spite of this, the government of India has been disputing the UNAIDS
numbers for years. They have a good reason for taking this political
risk. Public fear based on the numbers coming out of UNAIDS, which
currently exceeds observed reality by 50-fold in India, was serving to put
pressure on the government to divert public funds from desperately needed
control of tuberculosis and other treatable diseases into further HIV/AIDS
efforts. Yet according to the official governmental National AIDS Control
Organization (NACO), “there is no basis for these [UNAIDS]
projections.” As such, NACO demanded UNAIDS either rationalize
their projections or retract them. Unable to offer any justification,
UNAIDS finally acquiesced in 2000, and revised their report for India
stripping it of ALL hypothetical AIDS deaths. The space for “AIDS
deaths 2001” is also left blank for India in the new 2002 UNAIDS
report as well. Had the WHO/UNAIDS not acquiesced, India, which carries
about 25% of the worlds TB burden, may have witnessed
hundreds-of-thousands of “real deaths” far in excess of even
the “virtual deaths” on the computers in Geneva? We will see
how India’s defiance on this issue will affect the size of their
piece of the projected US$10 billion/year WHO HIV/AIDS pie. Apparently,
they felt that saving hundreds-of-thousands of real humans, as compared to
virtual humans, was worth the political risk.

It is also important to note that all other UNAIDS projections such as,
“life-expectancy,” “orphans,” “loss of work
force,” and “loss of teachers,” are also based on the
assumption that all the virtual deaths in these computer models are real.
So when we see statements like, “life expectancy in Botswana has
dropped below 40 for the first time since 1950,” this has nothing to
do with any actual measurement of death rates among the real humans living
in Botswana. In fact, no one knows what life expectancy is in Botswana.
It is also important to know that the current 14 million children orphaned
by AIDS are simply unknown children who must exist somewhere because one
of their parents died of “computer AIDS.”

In summary, the representatives of UNAIDS who are responsible for putting
this information forward as evidence that antiretroviral therapy is saving
people are either scientifically ignorant, or they are knowingly
attempting to deceive the public as a means to an end; namely, $10 billion
a year in funding by 2005.

Yet, as Dr. Peter Piot (executive director of UNAIDS) puts it,
“It’s not asking for the moon.” (Rueters, July 2,
2002.) No…more like the earth!


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