Every three months, the Geneva-based World Health Organization publishes a report on the estimated number of people worldwide who are infected with human immunodeficiency virus (HIV) and the number who have, as a result, developed the debilitating and ultimately fatal acquired immune deficiency syndrome (AIDS). The WHO’s latest report, published in mid-February, portrayed a rapidly spreading disease, with one million new HIV infections during the previous eight months, bringing the total worldwide to about 12 million. It predicted an even grimmer future, with as many as 40 million people HIV-infected by the year 2000. But a growing number of critics, in both Canada and the United States, contend that the WHO estimates are unrealistic and misleading. In fact, they say that the spread of the deadly virus in North America peaked during the mid1980s, and that a two-year-old decline in the number of new AIDS cases diagnosed annually is a trend that will continue through the 1990s. Said Joel Hay, a health economist at the University of Southern California in Los Angeles: “I don’t trust the WHO reports on the number of people infected with HIV, in Africa or anywhere else. Their estimates have been wildly exaggerated.”
The figures from the WHO, an organization affiliated with the United Nations, also raised some doubts about the threat that AIDS poses to the population as a whole. Most experts agree that in the developing countries of Africa, Asia and the Caribbean, HIV is spread largely through heterosexual intercourse. As a result, roughly equal numbers of men and women eventually contract AIDS. But Canadian and U.S. government statistics show that, despite warnings that AIDS could spread rapidly among heterosexuals, in North America AIDS remains overwhelmingly a disease that affects homosexual and bisexual men and intravenous drug users. Some experts now contend that AIDS activists in both countries have made misleading claims about the disease’s potential for spreading among heterosexuals in order to encourage funding for AIDS research and prevention. Said Alexander Langmuir, a former chief epidemiologist with the Atlanta-based Centers for Disease Control: “There are no signs of a rampant new wave of AIDS. It’s clearly a disease that is largely restricted to gays and drug addicts.”
Those views are by no means universal in the
AIDS research community. The total number of AIDS cases diagnosed in Canada fell to 965 in 1990 from 1,142 in 1989, and incomplete figures for last year suggest that the decline continued. Similarly, figures compiled by the Centers for Disease Control show that there were 28,193 new cases of AIDS diagnosed in the United States in the year ending Feb. 29,1992, down from 38,684 a year earlier. But Mark Wainberg, director of the McGill AIDS Centre in Montreal, said that the figures do not necessarily mean that the spread of AIDS has peaked. Earlier detection of HIV infection and improved treatments have delayed the number of AIDS cases being diagnosed, he said. In the absence of a cure, he added, almost all HIV infections are likely to develop into the fatal disease.
As well, activists deny that they have tried to manipulate public opinion about AIDS. Said Richard Burzynski, executive director of the Ottawa-based Canadian AIDS Society: “It’s a complete falsehood to suggest that there has been some kind of conspiracy to try to keep people’s attention on AIDS.”
> While the overall status of the epidemic is
S PEAKED IN CANADA?
Cases contracted through heterosexual activity Cases contracted in other ways
debatable in North America, WHO officials insist that AIDS is still increasing at an explosive rate in the developing world. In December, 1988, the WHO announced that it had received official medical reports of 130,000 cases of AIDS from 140 countries. By February, 1992, the number of reported cases had jumped to 450,000. The organization estimates that the actual number of AIDS cases is probably closer to two million, and attributes the discrepancy to underreporting by many Third World countries.
WHO officials have also consistently raised their estimates of the number of potential
victims. In December, 1988, the organization estimated that five million people worldwide were infected with HIV.
Currently, it predicts that there will be 40 million infections by the year 2000. Rand Stonebumer, a WHO epidemiologist in Geneva, said that the HIV estimates are based on anonymous testing of pregnant women at prenatal clinics, as well as testing of male and female patients who seek treatment for other sexually transmitted diseases.
He added that the testing and collection of data is handled by individual countries in most cases and then submitted to the WHO.
Still, some health officials in Canada and the United States claim that it is difficult to estimate the number of HIV infections with any accuracy.
Dr. Ruth Berkelman, acting director of the Centers for g
Disease Control’s Hiv/AIDS division, said that it does not keep HIV infection statistics because there are no reliable methods of collecting them.
And the University of Southern California’s Hay contends that the WHO deliberately overestimates the number of HIV infections, largely for political reasons. Said Hay: “They and other AIDS bureaucracies have a vested interest in painting the bleakest picture possible, because that’s how they get their money.”
By contrast, there is a consensus among experts about the different patterns for the spread of the disease in the Western world and in developing countries. Dr. Frank Plummer, for one, a University of Manitoba specialist on infectious diseases, has spent the past eight years studying AIDS in Kenya. He attributes the African epidemic to socioeconomic conditions, particularly in major urban areas where large numbers of migrant male workers, combined with female poverty, have created huge sex trades.
Plummer said that in Africa, HIV spreads through heterosexual intercourse largely because of the prevalence of other sexually transmitted diseases, particularly chancroid, that cause open genital sores. He said that HIV from an infected man or woman enters the bloodstream of an uninfected sex partner through those breaks in the skin. Plummer added that the devastation of AIDS is undeniable, and that “In some places in Africa, half the hospital beds are taken up with AIDS patients.”
In North America, meanwhile, AIDS surveillance reports compiled by the Canadian and U.S. governments show that the disease is still not spreading in large numbers through het-
erosexual intercourse. About 80 per cent of the cases in Canada since the early 1980s have occurred among gay or bisexual men, while heterosexual activity accounted for only 4.3 per cent of the cases. (The rest were a result of drug users’ needles, contaminated blood transfusions, transmission in the womb or from undetermined causes.)
In the United States, officials of the Centers for Disease Control say that gay males, bisexual males or intravenous drug users account for 86 per cent of the cases. Among heterosexuals, who account for six per cent of American AIDS cases, most became infected with HIV by having sex with a bisexual male or an intravenous drug user. Reports from Canada and the United States also show that the number of new cases of AIDS diagnosed in both countries has dropped in the past two years for which complete figures are available. Said Berkelman bluntly: “AIDS is not going to be a major heterosexual epidemic in the United States.”
The controversy over funding arises from the fact that, although AIDS is still incurable, it does not rank among the leading causes of death in either Canada or the United States. It has killed 138,395 people in the United States since the early 1980s, while heart disease, the leading cause of death, claimed almost 734,000 American lives in 1989 alone, the latest year for which figures are available. Similarly, AIDS has caused 3,432 deaths in Canada during the same period, while heart disease killed 63,872 Canadians in 1989.
Still, the Canadian government distributed a
total of $16 million for AIDS research in the year ended March 31, 1992, compared with about $13 million for heart research. Washington put $1.5 billion into AIDS research and $864 million into heart research during the fiscal year ended last Sept 30. “AIDS activists have been misleading the public for years,” said Los Angelesbased journalist Michael Fumento, author of the 1990 book The Myth of Heterosexual AIDS. “Polls show over and over again that AIDS is the number 1 public health concern in America. But AIDS isn’t even among the Top 10 causes of death in America. If people don’t know that, they are going to support this massive funding for AIDS research.”
Some observers contend that the decline in the number of new AIDS cases in North America indicates that the spread of Hrv actually peaked during the early 1980s. In all likelihood, no more than 650,000 Americans have been infected with HIV, Hay said, and the majority of them had acquired the virus by 1986. Eric Mintz, an epidemiologist and instructor at Ryerson Polytechnical Institute in Toronto, said that HIV/AIDS seems to be following the pattern of most epidemics: spreading rapidly before reaching a plateau and then beginning to decline. “We have a lot of knowledge about the way diseases behave, but we have ignored it all with AIDS,” said Mintz. “I was on a provincial task force on AIDS in early 1988 and I couldn’t believe what we were telling the public. We were predicting 20,000 AIDS cases in Canada by 1990. Well, there were about 5,000. So we were wrong by 400 per cent.”
Still, Canadian medical practitioners report that the disease is still putting new groups at risk, notably women and children. Dr. William Cameron, director of the AIDS clinic at Ottawa General Hospital and a leading Canadian researcher into the disease, said that 10 per cent of the 700 patients at his clinic are women. Six years ago, he did not have any female patients. At the same time, Dr. Stanley Read, an infectious-disease specialist who works at Toronto’s Hospital for Sick Children, said that the hospital has treated about 80 HIV-infected children during the past two years. He said that roughly 30 of the children were bom to infected mothers, and the rest picked up the virus through contaminated blood products.
With no cure for the disease yet in sight, AIDS activists in both Canada and the United States are still pleading for more government funding for research. Ottawa’s Burzynski said that the Canadian AIDS Society is planning a major lobbying effort because Ottawa’s five-year, $ 129million commitment to research and education expires in a year. Iris Long, a member of ACT UP New York, an AIDS organization that campaigns to draw attention to the disease, insists that “AIDS is still an epidemic, and still needs massive funding for research and prevention.” But as the debate over the exact size and nature of the sinister epidemic unfolds, a growing number of critics are challenging some of the basic assumptions of the AIDS lobby.
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