<http://www.guardian.co.uk/world/2008/may/13/aids.hiv>:

----- Begin Quote -----

When Elizabeth Pisani began her career as an HIV epidemiologist, fewer
than 1.5m cases of Aids had been reported across the world. Within a
year, by the end of 1997, 30 million people were estimated to be
infected with HIV. As Pisani wrote in her first report for World Aids
Day, that meant one in every 100 sexually active adults aged between
15 and 49 worldwide.

Today, just over a decade later, the global figure is estimated to be
closer to 40 million, with more than 1.5m new infections every year.

----- End Quote -----

Notice how this article begins by mentioned AIDS: "...fewer than 1.5m
cases of Aids...," and then suddenly jumps to talking about HIV:
"Within a year, by the end of 1997, 30 million people were estimated
to be infected with HIV."

This trick is often used by believers in HIV to talk up the numbers.
HIV is not AIDS, and to carelessly swap around the statistics as if
they are is extremely misleading.

Oh, and according to <http://www.avert.org/worldstats.htm> the global
estimate of the HIVAIDS cases is 33.2 million.

The rest of the article isn't so bad, and contains an interesting
insight into the murky world of HIV.

----- Begin Quote -----

Ten years ago, the developing world received roughly $300m a year from
the west. By 2007, the figure was $10bn. This year the US alone has
budgeted $5bn for HIV in developing countries - and last month the US
Congress voted to commit a further $50bn over the next five years. The
President's Emergency Plan For Aids Relief (Pepfar), personally
initiated by George W Bush, has been described in Washington as the
most successful foreign aid programme since the Marshall Plan, and
"the best thing that ever happened to the poor people I work with" by
one HIV programme leader in Africa. On a recent visit to the
continent, Bush was feted as the saviour who has put one and a half
million Africans on life-saving drugs.

"We used to sit around fantasising about having unlimited resources,"
Pisani recalls. "Like winning the lottery." Today, the Aids industry -
"or Aids mafia", in her words - effectively has won the lottery. But
Pisani is not celebrating. Her book, The Wisdom of Whores, published
this week, condemns the global strategy for Aids as an ill-conceived
waste of money which is not saving but costing lives.

"HIV is mostly about people doing stupid things in the pursuit of
pleasure or money," declares the cover on a proof copy of the book.
"We're just not allowed to say so." She suspects she will never work
in the Aids industry again for saying so. "But it's true."

Pisani, 43, spent 10 years working in the field of HIV, first for
Unaids and then for a non-governmental organisation (NGO) in
Indonesia. As an epidemiologist, she quickly identified the risk of
the virus spreading among drug injectors, gay men and the sex trade
across Asia, Latin America and Eastern Europe - underdeveloped
countries with inadequate resources to prevent an epidemic. That
placed 100 million at risk in Asia alone - equivalent to a third of
the population of the Africa. But the data was clear: "HIV wasn't
going to rage through the billions in the 'general population'. And we
knew it."

Like most of her colleagues, however, she also quickly realised that
"governments don't like spending money on sex workers, gay men and
drug addicts". So she put her skills as a former journalist to work,
and began producing the sort of reports that persuaded politicians in
Washington and the west that it is not "wicked people" but "innocent
wives" at risk. "Aids couldn't be about sex and drugs," she explains.
"So suddenly it had to be about development, and gender, and blah blah
blah."

The strategy was more successful than she could ever have imagined.
"All these obsessively politically correct things started getting
introduced." HIV publications and conferences began devoting more time
and attention to issues such as poverty, gender, development,
vulnerability, leadership - what Pisani calls "sacred cows" - than to
condoms and clean needles. "I'm just waiting for 'climate change and
Aids'," she jokes sarcastically in her book - and sure enough, this
week a headline appeared in an Australian newspaper: "Global warming
set to fan HIV."

These were all far more palatable issues to politicians than sex and
drugs, and the money began to roll in. But they are not, Pisani
argues, what cause Aids. "We have to stop this nonsense now. Talking
about 'vulnerability' will not stop people getting infected."

Pisani's relief at being free now to "tell it how it is" is palpable.
After gaining a degree in classical Chinese, she joined Reuters as a
reporter in the far east, and then took a masters in medical
demography in London in the early 90s. She quit the field to write her
book, and people are often surprised to discover she is an
epidemiologist, because her charisma and sense of irony would be more
familiar to a foreign correspondent's club than an NGO. "Basically,"
she likes to say, "my book is about sex, drugs and taxation." It is
easy to see why she grew exasperated with UN colleagues who would
exchange tortuous memos agonising over the most sensitive wording of
something as simple as "men who have sex with men". She wasn't hostile
to their liberal instincts - just impatient that semantics were
wasting time, when people were dying.

There are two distinctly separate Aids epidemics, she says - one in
Africa, and one in the rest of the world. In Africa, people are
contracting the virus through heterosexual, non-commercial sex. But in
most of the world, Pisani claims, the data clearly indicates that the
risk is confined to drug users, sex workers and gay men - the very
groups that Aids organisations have worked so hard to distance from
the problem. Yet all the evidence of focused programmes which target
these high-risk groups with effective preventative measures - condom
use and clean needles - is that they work.

"We could knock this epidemic in the rest of the world on the head -
just like we've knocked so many things on the head in the rest of the
world - but we're not doing it, largely because of the paradigm that
we're developing in Africa. The Aids industry has become an island
unto itself, in a sea of common sense. That's the tragedy of it. It's
unsayable."

There is more than a touch of the maverick iconoclast about Pisani.
The Wisdom of Whores is full of exotic anecdotes from the colourful
world of transgender prostitutes, and the language - like her manner -
is lively. But the book is built around a solid body of scientific
evidence, and the blend of data analysis and straight talking makes a
very persuasive argument. But if Pisani is right, why isn't anyone
else making it?

"If you are a data nerd, you spend your whole time looking at the
numbers, and the conclusions are fairly inescapable. So a lot of the
data nerds feel the same way as me. But at the NGO level, of UN
organisations, we've been spouting all this stuff about development
and poverty for so long that if you don't look at the data, if you
just listen to the rhetoric, you'd be completely forgiven for
believing that stuff."

Even if Pisani is right about the rest of the world, what can be wrong
with a global strategy for Africa which has brought antiretroviral
drugs (ARVs) to one and a half million of the poorest people in the
world? It is easy to mock talk of "gender and development and blah
blah blah", but it has persuaded a conservative president to fund HIV
treatment on a previously unimaginable scale. Bush's motive may be
unconventional - he is said to see global HIV as a US national
security - but surely, I suggest, if he throws enough money at the
wall, some of it will stick.

"Not if you're chucking it at the wrong wall."

The problem, Pisani says, is that 80% of the Pepfar budget goes on
treatment. "Pepfar says great, we've got 1.8 million people in
treatment. And next year it will be another 1.8 million! That will
mean 3.6 million people. It's exponential - and that's the biggest
question mark over the entire approach to Africa. The more treatment
you have, the more infection you get."

ARVs reduce people's viral load, she agrees, making them less likely
to infect someone else - as long as they don't miss a single dose.
"But it also keeps them alive longer, and healthy enough to want to
have sex. You only have to look at the experience of the UK or US gay
communities where we've had more or less universal access to ARVs for
at least eight or nine years, and the number of new infections are
rising. More people are living longer with HIV, and there is what we
call behavioural disinhibition: 'f.ck the condoms, I don't need them
any more, because if he's positive he'll be on drugs, so he probably
won't infect me. And if I do get infected, it would be annoying, but
not the end of the world.'

"But having Aids is not a picnic. Yes, it's great that all this stuff
on treatment is happening. But it becomes all the more urgent to have
effective prevention. And that's not happening."

Even the 20 cents in every US dollar allowed to be spent on prevention
is wasted, Pisani argues. A third of the prevention budget has to be
allocated to faith-based organisations, which refuse to distribute
condoms and will promote only abstinence before marriage. The failure
rate of "virginity pledge" programmes among young Americans in the US
is about 75%; condoms' failure rate is roughly 2%. Yet Pepfar, Pisani
laughs, "claims its policy decisions are 'evidence based'".

Pisani's criticism of the treatment-and-abstinence approach in Africa
has been echoed elsewhere. The director of America's National
Institute of Allergy and Infectious Diseases told an international
conference last summer, "For every person who gets life-saving drugs,
six more are getting infected. Clearly, we're losing that game."
Richard Holbrooke, the former US ambassador to the UN, agrees.
"Focusing primarily on treatment will never succeed."

But if some in the Aids industry are willing to criticise the
contradictions driven by rightwing ideology, Pisani finds them far
less ready to admit the ideological motivation of their own "Poverty
causes Aids" agenda. They daren't say the virus is usually transmitted
by risky behaviour, she thinks, for fear of appearing "judgmental" and
confirming the old rightwing attitude that
people with HIV don't deserve to be cared for.

"A good friend of mine - he works in the industry and is a sensible
guy - called me up and said, 'You've got to change the blurb on the
cover of your book. You can't use the word stupid. You can't call
people stupid.' I said, 'I'm not calling people stupid, I'm saying
they do stupid things. Not the same thing.' But he said, 'You will get
absolutely crucified.' So I've had to change it to 'daft'."

She half laughs, and rolls her eyes.

"You know, it's one of the difficult things about arguing for a more
targeted response. You're basically saying, 'Look, people are getting
infected now because they're doing dumb things.' But people do dumb
things all the time. I do. We all do. Why is it OK to be judgmental
about people who smoke? But not to be judgmental about people who take
crystal meth and f.ck 16 guys in a weekend without condoms?"

Is Pisani judgmental?

"I don't think it's evil to have anal sex with 16 people in a weekend
without condoms. I just think if you do that there's a high likelihood
you're going to get infected. That's all. It's cause and effect. And I
think if we can prevent a fatal disease, we should. I don't get how
it's OK to keep someone alive once they're sick - but not OK to stop
them getting sick. I just don't get that."

----- End Quote -----