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's not asking
for the moon