UNAIDS Defends Their Math Skills

Yesterday the CSIS Task Force on HIV/AIDS invited Paul De Lay and Karen Stanecki of UNAIDS to discuss Craig Timberg’s recent article in the Washington Post accusing UNAIDS of inflating the HIV prevalence numbers (previously covered here). The Editorial Board followed Timberg’s article with an editorial questioning the credibility of UNAIDS.A summary of their discussion is below.Stanecki gave a persuasive explanation of how UNAIDS and its expert panels arrive at their estimates, noting that the predictive model changes over time as they refine their approach. Many of us who have been in Eastern and Southern Africa over the last few years are hardly surprised by these new figures, and we understand how hard it is to get an accurate estimate. The country-led approach that UNAIDS is fostering should increase ownership and improve data reliability.Paul De Lay brought up some very interesting points that will figure in UNAIDS’ report at the upcoming UNGASS. First, it is really hard to measure the quality of ARV treatment being provided. He is absolutely right; as we scale up ART throughout the developing world, we need better measures to ensure that people are receiving the right drugs, at the right time, and are responding correctly to the drugs. So far, we aren’t doing a good enough job measuring the quality of care, and this could hurt us in the future with increased drug resistance.Second, prevention efforts are stalling. Putting pills in mouths is easier to measure than new infections averted, and we aren’t doing enough work to learn how to do good prevention. The current MTCT coverage rate is 9% - that is just not acceptable. Also, fewer than 50% of youths age 15-24 can answer basic facts about preventing HIV.Finally, Sub-Saharan Africa is doing a pretty good job putting women on treatment, other than in the MTCT programs. Generally the percent of women get ART tracks pretty close to the gender makeup of the epidemic in each country. Latin America however is behind in getting women on ART.Overall, many interesting issues, and there should be plenty more debate in the days leading up to the UNGASS. Stay tuned!