Monday, September 15, 2008

AIDS epidemic? It was a `glorious myth'

The author of 1987's "The Truth About the AIDS Panic" welcomes two new whistleblowing texts on the opportunism of the AIDS industry.

There is a widely accepted view that Britain was saved from an explosive epidemic of heterosexual AIDS in the late 1980s by a bold campaign initiated by gay activists and radical doctors and subsequently endorsed by the government and the mass media. According to advocates of this view, we owe our low rates of HIV infection today largely to the success of initiatives such as the `Don't Die of Ignorance' leaflet distributed to 23million households and the scary `Tombstones and Icebergs' television and cinema adverts (though they are always quick to add that we must maintain vigilance and guard against complacency).

Now former AIDS industry insiders are challenging the imminent heterosexual plague story and many of the other scare stories of the international AIDS panic. James Chin, author of The AIDS Pandemic: The Collision of Epidemiology with Political Correctness, is a veteran public health epidemiologist who worked in the World Health Organisation's Global Programme on AIDS in the late 1980s and early 1990s. Elizabeth Pisani, a journalist turned epidemiologist and author of The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS, spent most of the past decade working under the auspices of UNAIDS, which took over the global crusade against HIV in 1996. Once prominent advocates of the familiar doomsday scenarios, both have now turned whistleblowers on their former colleagues in the AIDS bureaucracy, a `byzantine' world, according to Pisani, in which `money eclipses truth'.

For Chin, the British AIDS story is an example of a `glorious myth' - a tale that is `gloriously or nobly false', but told `for a good cause'. He claims that government and international agencies, and AIDS advocacy organisations, `have distorted HIV epidemiology in order to perpetuate the myth of the great potential for HIV epidemics to spread into "general" populations'. In particular, he alleges, HIV/AIDS `estimates and projections are "cooked" or made up'.

While Pisani disputes Chin's claim that UNAIDS epidemiologists deliberately overestimated the epidemic, she admits to what she describes as `beating up' the figures, insisting - unconvincingly - that there is a `huge difference' between `making it up (plain old lying) and beating it up'. Pisani freely acknowledges her role in manipulating statistics to maximise their scare value, and breezily dismisses the `everyone-is-at-risk nonsense' of the British `Don't Die of Ignorance' campaign.

Chin's book offers a comprehensive exposure of the hollowness of the claims of the AIDS bureaucracy for the efficacy of their preventive campaigns. He provides numerous examples of how exaggerated claims for the scale of the HIV epidemic (and the risks of wider spread) in different countries and contexts enable authorities to claim the credit for subsequently lower figures, as they `ride to glory' on curves showing declining incidence. As he argues, `HIV prevalence is low in most populations throughout the world and can be expected to remain low, not because of effective HIV prevention programmes, but because. the vast majority of the world's populations do not have sufficient HIV risk behaviours to sustain epidemic HIV transmission'.

By the late 1980s, it was already clear that, given the very low prevalence of HIV, the difficulty of transmitting HIV through heterosexual sex and the stable character of sexual relationships (even those having multiple partners tend to favour serial monogamy), an explosive HIV epidemic in Britain, of the sort that occurred in relatively small networks of gay men and drug users, was highly improbable, as Don Milligan and I argued in 1987 (1).

As both Chin and Pisani indicate, high rates of heterosexually spread HIV infection remain the exceptional feature of sub-Saharan Africa (and parts of the Caribbean) where a particular pattern of concurrent networks of sexual partners together with high rates of other sexually transmitted infections facilitated an AIDS epidemic. Though this has had a devastating impact on many communities, Chin suggests that HIV prevalence in sub-Saharan Africa and the Caribbean has been overestimated by about 50 per cent. The good news is that, contrary to the doom-mongering of the AIDS bureaucracy, the rising annual global HIV incidence peaked in the late 1990s and the AIDS pandemic has now passed its peak.

Most significantly, the sub-Saharan pattern has not been replicated in Europe or North America, or even in Asia or Latin America, though there have been localised epidemics associated with gay men, drug users and prostitution, most recently in South-East Asia and Eastern Europe.

Many commentators now acknowledge the gross exaggerations and scaremongering of the AIDS bureaucracy. It is clear that HIV has remained largely confined to people following recognised high-risk behaviours, rather than being, in the mantra of the AIDS bureaucracy, a condition of poverty, gender inequality and under-development. Yet they also accept the argument, characterised by Chin as `political correctness', that it is better to try to terrify the entire population with the spectre of an AIDS epidemic than it is to risk stigmatising the gays and junkies, ladyboys and whores who feature prominently in Pisani's colourful account.

For Chin and Pisani, the main problem of the mendacity of the AIDS bureaucracy is that it leads to misdirected, ineffective and wasteful campaigns to change the sexual behaviour of the entire population, while the real problems of HIV transmission through high-risk networks are neglected. To deal with these problems, both favour a return to traditional public health methods of containing sexually transmitted infections through aggressive testing, contact tracing and treatment of carriers of HIV. Whereas the gay activists who influenced the early approach of the AIDS bureaucracy favoured anonymous and voluntary testing, our whistleblowers now recommend a more coercive approach, in relation to both diagnosis and treatment.

Pisani reminds readers that `public health is inherently a somewhat fascist discipline' (for example, quarantine restrictions have an inescapably authoritarian character) and enthusiastically endorses the AIDS policies of the Thai military authorities and the Chinese bureaucrats who are not restrained from targeting high-risk groups by democratic niceties. The problem is that, given the climate of fear generated by two decades of the `everyone-is-at-risk nonsense', the policy now recommended by Chin and Pisani is likely to lead to more repressive interventions against stigmatised minorities (which will not help to deter the spread of HIV infection).

Chin confesses that he has found it difficult `to understand how, over the past decade, mainstream AIDS scientists, including most infectious disease epidemiologists, have virtually all uncritically accepted the many "glorious" myths and misconceptions UNAIDS and AIDS activists continue to perpetuate'. An explanation for this shocking betrayal of principle can be found in a 1996 commentary on the British AIDS campaign entitled `Icebergs and rocks of the "good lie"'. In this article, Guardian journalist Mark Lawson accepted that the public had been misled over the threat of AIDS, but argued that the end of promoting sexual restraint (especially among the young) justified the means (exaggerating the risk of HIV infection): as he put it, `the government has lied and I am glad' (2).

This sort of opportunism is not confined to AIDS: in other areas where experts are broadly in sympathy with government policy - such as passive smoking, obesity and climate change - they have been similarly complicit in the prostitution of science to propaganda. It is a pity that Chin and Pisani did not blow their whistles earlier and louder, but better late than never.


'Don't blame fat kids on Maccas'

THE Australian head of McDonald's says there's no mystery surrounding childhood obesity - kids are fat because they don't exercise as much as they used to. Chief executive Peter Bush also says McDonald's, according to the chain's own research, provides just one in every 72 meals an average child eats. "You've got to look at those other 71 meals kids consume that often come out of the cupboard at home," Mr Bush told a federal parliamentary inquiry into obesity sitting in Sydney.

"Where we sit on this is that we probably look at it as a very perplexing and complicated issue. "Certainly the studies have indicated that the issue is linked to a change on lifestyle - kids exercising less, watching more TV, kids playing video games."

Mr Bush said academics where now properly studying the causes of obesity, but most pre-existing data blaming fast food was inconclusive. "When the very first obesity summit was held in Sydney in October 2002, my predecessor sat through the two days of that session," he said. "Through that time, overwhelming evidence was presented, but not substantiated, that fast food was the culprit. "What also emerged at that time was there were very few studies completed worldwide at that stage." Mr Bush said fear of crime was a factor in obesity, arguing parents do not allow children to walk to school anymore.

The House of Representatives standing committee inquiry, which began in May, is looking at the increasing prevalence of obesity and future implications for the health system. University of Sydney Associate Professor Jenny O'Dea presented the findings of a study on obese children and a survey of 345,713 adults. It showed poorly-educated parents were more than twice as likely to have obese children as well-educated mums and dads.

The Roy Morgan survey also showed the rate of obesity for adults in the lowest socio-economic groups grew at almost triple the rate of those belonging to the highest earning and educated groups between April 2000 and March 2007. Nearly a third of people in the lowest socio-economic group were regarded as obese in March last year, compared with 26.6 per cent in April 2000. In the highest socio-economic group, 17.8 per cent were obese, up from 15.9 in 2000.

Dr O'Dea said governments should rethink obesity campaigns, saying they must address social inequities rather than opting for "shame and blame" strategies, which did not work. She also said the international standard for measuring obesity was generally fair, but the label should be treated with care as the body mass of some ethnic groups differed. "You can't assume that an overweight, obese child is carrying too much fat," she said. "There are kids who fit into that category. They are the the Samoan kids and the Fijian kids and the Greek boys who are very muscular and the Lebanese boys."

Dr O'Dea studied 960 families of children, from years two to six, in 10 primary schools across regional and rural NSW. She discovered 2.7 per cent of tertiary-educated mothers had obese children compared with six per cent of mums who had completed year 10 or less. Seven per cent of fathers in the low-educated group had obese children, while the figure was three per cent for those in the highly-educated group.


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