Sida: beaucoup de bruit pour rien?

[Taranne]

The exploitation of Aids

The Aids scare was one of the most distorted, duplicitous and cynical public health panics of the last 30 years

* Brendan O'Neill

Finally we have a high-level admission that there is no threat of a global Aids pandemic among heterosexuals. After 25 years of official scaremongering about western societies being ravaged by the disease – with salacious, tombstone-illustrated government propaganda warning people to wear a condom or "die of ignorance" – the head of the World Health Organisation's HIV/Aids department says there is no need for heterosexuals to fret.

Kevin de Cock, who has headed the global battle against Aids, said at the weekend that, outside very poor African countries, Aids is confined to "high-risk groups", including men who have sex with men, injecting drug users, and sex workers. And even in these communities it remains quite rare. "It is very unlikely there will be a heterosexual epidemic in countries [outside sub-Saharan Africa]", he said. In other words? All that hysterical fearmongering about Aids spreading among sexed-up western youth was a pack of lies.

Much of the media has treated Dr De Cock's admission as a startling revelation. In truth, experts have known for many years that in the vast majority of the world, Aids has little impact on the "general population". In her new book The Wisdom of Whores, Elizabeth Pisani – who worked for 10 years in what she refers to as "the Aids bureaucracy" – admits that by 1998 it was clear that "HIV wasn't going to rage through the billions in the 'general population', and we knew it".

Some people knew it earlier. In 1987, my friend and colleague Dr Michael Fitzpatrick wrote a fiery pamphlet titled The Truth About the Aids Panic. At the height of the Conservative government's scary tombstone campaign ("Don't die of ignorance"), he wrote: "There is no good evidence that Aids is likely to spread rapidly in the West among heterosexuals." In Britain, most of the small-scale spread of "heterosexual Aids" has been a result of infected individuals arriving from Africa. In the UK in the whole of the 1980s – the decade of the Great Aids Panic – there were 20 cases of HIV acquired through heterosexual contact with an individual infected in Europe.

And it isn't the case that the heterosexual pandemic failed to materialise because officialdom's omnipresent pro-condom propaganda was a success. According to James Chin, a clinical professor of epidemiology at the University of California at Berkeley and author of the new book The Aids Pandemic, it was always a "glorious myth" that there would be an "HIV epidemic in general populations". That myth was the product of "misunderstanding or deliberate distortions of HIV epidemiology" by Unaids and other Aids activists, says Chin.

It is time to recognise that the Aids scare was one of the most distorted, duplicitous and cynical public health panics of the past 30 years. Instead of being treated as a sexually transmitted disease that affected certain high-risk communities, and which should be vociferously tackled by the medical authorities, the "war against Aids" was turned into moral crusade.

Both Conservative and New Labour governments exploited the disease to create a new moral framework for society. Through baseless fearmongering, officials sought to police and regulate the behaviour of the public. No longer able to appeal to outdated Victorian ideals of chastity or restraint, the powers-that-be used the spectre of an Aids calamity to terrify us into behaving "responsibly" in sexual and social matters.

They were aided and abetted by the rump of the radical left. Gay rights campaigners, feminists and left-leaning health and social workers stood shoulder-to-shoulder, first with the Tories and later with Labour, in spreading the "glorious myth" of a possible future Aids pandemic. An unholy alliance of old-style, prudish conservatives and post-radical, lifestyle-obsessed leftists latched on to Aids as a disease that might provide them with a sense of moral purpose.

And they ruthlessly sought to silence anyone who questioned them. Those who challenged the idea that Aids would devour sexually promiscuous young people and transform once-civilised western societies into diseased dystopias were denounced as "Aids deniers" and "heretics". Anyone who suggested that homosexuals were at greater risk than heterosexuals – and therefore the focus of government funding and, where necessary, medical assistance should be in gay communities – was denounced as homophobic. Nothing could be allowed to stand in the way of the glorious moral effort to make everyone submit to the sexual and moral conformism of the Aids crusaders.

Even in Africa – where there is a serious and deadly Aids crisis in some countries – the international focus on Aids has been motivated more by pernicious moralism than straightforward charity. Diseases such as malaria and tuberculosis are bigger killers than Aids. Yet focusing on Aids allows western governments and NGOs to lecture Africans about their morality and personal behaviour. It also adds a new gloss to the misanthropic population-control arguments of western charities, which now present their promotion of condoms in "overly fecund" Africa as a means of preventing the spread of disease.

The relentless politicisation and moralisation of Aids has not only distorted public understanding of the disease and generated unnecessary fear and angst – it has also potentially cost lives. James Chin estimates that UNAIDS wastes around $1bn a year in activities such as "raising awareness" about Aids and preventing the emergence of the disease in communities that are at little risk. How many lives could that kind of money save, if it were used to develop drugs and deliver them to infected or at-risk communities? It is time people treated Aids as a normal disease, rather than as an opportunity for spreading their own moral agendas.

Threat of world Aids pandemic among heterosexuals is over, report admits

A 25-year health campaign was misplaced outside the continent of Africa. But the disease still kills more than all wars and conflicts

By Jeremy Laurance

Sunday, 8 June 2008

A quarter of a century after the outbreak of Aids, the World Health Organisation (WHO) has accepted that the threat of a global heterosexual pandemic has disappeared.

In the first official admission that the universal prevention strategy promoted by the major Aids organisations may have been misdirected, Kevin de Cock, the head of the WHO's department of HIV/Aids said there will be no generalised epidemic of Aids in the heterosexual population outside Africa.

Dr De Cock, an epidemiologist who has spent much of his career leading the battle against the disease, said understanding of the threat posed by the virus had changed. Whereas once it was seen as a risk to populations everywhere, it was now recognised that, outside sub-Saharan Africa, it was confined to high-risk groups including men who have sex with men, injecting drug users, and sex workers and their clients.

Dr De Cock said: "It is very unlikely there will be a heterosexual epidemic in other countries. Ten years ago a lot of people were saying there would be a generalised epidemic in Asia – China was the big worry with its huge population. That doesn't look likely. But we have to be careful. As an epidemiologist it is better to describe what we can measure. There could be small outbreaks in some areas."

In 2006, the Global Fund for HIV, Malaria and Tuberculosis, which provides 20 per cent of all funding for Aids, warned that Russia was on the cusp of a catastrophe. An estimated 1 per cent of the population was infected, mainly through injecting drug use, the same level of infection as in South Africa in 1991 where the prevalence of the infection has since risen to 25 per cent.

Dr De Cock said: "I think it is unlikely there will be extensive heterosexual spread in Russia. But clearly there will be some spread."

Aids still kills more adults than all wars and conflicts combined, and is vastly bigger than current efforts to address it. A joint WHO/UN Aids report published this month showed that nearly three million people are now receiving anti-retroviral drugs in the developing world, but this is less than a third of the estimated 9.7 million people who need them. In all there were 33 million people living with HIV in 2007, 2.5 million people became newly infected and 2.1 million died of Aids.

Aids organisations, including the WHO, UN Aids and the Global Fund, have come under attack for inflating estimates of the number of people infected, diverting funds from other health needs such as malaria, spending it on the wrong measures such as abstinence programmes rather than condoms, and failing to build up health systems.

Dr De Cock labelled these the "four malignant arguments" undermining support for the global campaign against Aids, which still faced formidable challenges, despite the receding threat of a generalised epidemic beyond Africa.

Any revision of the threat was liable to be seized on by those who rejected HIV as the cause of the disease, or who used the disease as a weapon to stigmatise high risk groups, he said.

"Aids still remains the leading infectious disease challenge in public health. It is an acute infection but a chronic disease. It is for the very, very long haul. People are backing off, saying it is taking care of itself. It is not."

Critics of the global Aids strategy complain that vast sums are being spent educating people about the disease who are not at risk, when a far bigger impact could be achieved by targeting high-risk groups and focusing on interventions known to work, such as circumcision, which cuts the risk of infection by 60 per cent, and reducing the number of sexual partners.

There were "elements of truth" in the criticism, Dr De Cock said. "You will not do much about Aids in London by spending the funds in schools. You need to go where transmission is occurring. It is true that countries have not always been good at that."

But he rejected an argument put in The New York Times that only $30m (£15m) had been spent on safe water projects, far less than on Aids, despite knowledge of the risks that contaminated water pose.

"It sounds a good argument. But where is the scandal? That less than a third of Aids patients are being treated – or that we have never resolved the safe water scandal?"

One of the danger areas for the Aids strategy was among men who had sex with men. He said: " We face a bit of a crisis [in this area]. In the industrialised world transmission of HIV among men who have sex with men is not declining and in some places has increased.

"In the developing world, it has been neglected. We have only recently started looking for it and when we look, we find it. And when we examine HIV rates we find they are high.

"It is astonishing how badly we have done with men who have sex with men. It is something that is going to have to be discussed much more rigorously."

The biggest puzzle was what had caused heterosexual spread of the disease in sub-Saharan Africa – with infection rates exceeding 40 per cent of adults in Swaziland, the worst-affected country – but nowhere else.

"It is the question we are asked most often – why is the situation so bad in sub-Saharan Africa? It is a combination of factors – more commercial sex workers, more ulcerative sexually transmitted diseases, a young population and concurrent sexual partnerships."

"Sexual behaviour is obviously important but it doesn't seem to explain [all] the differences between populations. Even if the total number of sexual partners [in sub-Saharan Africa] is no greater than in the UK, there seems to be a higher frequency of overlapping sexual partnerships creating sexual networks that, from an epidemiological point of view, are more efficient at spreading infection."

Low rates of circumcision, which is protective, and high rates of genital herpes, which causes ulcers on the genitals through which the virus can enter the body, also contributed to Africa's heterosexual epidemic.

But the factors driving HIV were still not fully understood, he said.

"The impact of HIV is so heterogeneous. In the US , the rate of infection among men in Washington DC is well over 100 times higher than in North Dakota, the region with the lowest rate. That is in one country. How do you explain such differences?"