Nature Medicine | Spoonful of Medicine

Needed: overhaul of AIDS programs

Last week’s Nature carried a fascinating review of two new books that take an unsparingly critical look at the world’s response to the AIDS epidemic.

The first, James Chin’s The AIDS Pandemic: The Collision of Epidemiology with Political Correctness, argues that flawed mathematical models have exaggerated the scale of the epidemic. Chin’s idea, which as we’ve reported has been gaining traction, is that tracking infection rates in pregnant women falsely inflates the numbers. Chin goes on to say that UNAIDS continues to support the bigger numbers because, among other things, it helps bring in donor money. That I can believe.

India was one of the first places where the numbers are lower than predicted by the mathematical models, but I’m not sure I agree with Chin that India’s epidemic won’t be as grave as the UN predicts it will be. Just last week, the government reported an alarming increase in prevalence in two Indian states. Based on my experience reporting on AIDS in India I think the numbers are likely to be much higher, not lower, than the ones we see reported.

The second book, Helen Epstein’s The Invisible Cure: AIDS in Africa, argues that indigenous efforts, particularly in reducing the average number of sexual partners, and not UNAIDS-sponsored methods, have been the most effective in curbing the AIDS epidemic in Africa.

The review is worth reading in its entirety, not least because it’s written by Stephen Lewis and his colleague Paula Donovan. Lewis, who was until December the UN special envoy for AIDS in Africa, is one of the most charismatic and genuine men I’ve ever met. When I interviewed him last year for a profile, his eyes repeatedly welled up when he talked about AIDS in Africa. I suspect he also has a lot to say about the UN, where he was not particularly popular because of his outspoken views. Now there’s a book I’m dying to read.

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