Garrett: HIV/AIDS Still Poorly Measured

On the annual occasion of World AIDS day, CFR health expert Laurie Garrett points to problems in tracking and addressing the disease.

November 30, 2007

To help readers better understand the nuances of foreign policy, CFR staff writers and Consulting Editor Bernard Gwertzman conduct in-depth interviews with a wide range of international experts, as well as newsmakers.

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Infectious Diseases

Health Policy and Initiatives

Laurie Garrett, CFR senior fellow for global health, says the recent decision (PDF) by the United Nations to lower numbers on HIV/AIDS infection rates was the result of a lack of capacity to get real numbers on the ground. Garrett also says the recent distress over new findings that U.S. infections most likely originated from Haiti shows that AIDS continues to be a “highly stigmatized disease” that is still “politically volatile.”

The United Nations recently reduced the estimates (PDF) for AIDS infections worldwide. How does that affect what’s happening on the ground, and what’s been done to address the statistical problems?

There is a lot of controversy about the new HIV/AIDS numbers because [the UN] lowered their estimates by 6 million roughly. And there were many who quickly jumped on this and said ‘See, they never really knew what they were talking about, they had been making the numbers up for years.’  And some jumped and said ‘See, this proves what we’ve been doing, we’ve reduced the number of people, blah, blah.’ All of that is incorrect.

What in reality has happened is we have to use [certain] markers for HIV in society because we didn’t have people on the ground with the skill set, nor the political support from governments to do the kinds of door-to-door surveys, household surveys and so on that could have revealed more meaningful figures for what was actually going on with HIV/AIDS.

What we needed all along, and when I said all along—for more than twenty-five years now—was a much more substantial way for measuring who has AIDS and who doesn’t have AIDS. And only now after many years trying to build up those measuring capacities and come up with better system to generate this number have we reached the point where we have some credibility to how we estimate AIDS. By the way, I should point out that in the United States we have probably the worst HIV/AIDS measurement of any wealthy country in the entire world.

What’s going on as far as new treatments for AIDS?

HIV/AIDS treatment is proving very successful wherever it is done properly. The hang-ups are two-fold. One is doing it properly, meaning do you have an infrastructure; do you have safe drinking water; do you have clinics and personnel to do the job? And the other is, eventually a certain percentage of your population that is on AIDS treatment is going to develop resistant viruses that can no longer respond to the cheap frontline drug.

Then you have to think about whether or not you as a country or you as a donor—whether its PEPFAR, [President Bush’s emergency plan for AIDS relief] our American program, or it’s a charitable donation group—whether you can afford the much more expensive second and third-line therapies and that is where the stumbling block is today. That’s really the stumbling block for countries like Brazil that have been treating their HIV populations for many years. And so they have a substantial percentage of population that no longer has viruses that are vulnerable to the cheap frontline drug. Now they have to go to the much more expensive treatments as we have had to do in theUnited States, and of course has been the case through out the Europe. So this is the new juncture and the new place where we are headed.

 Any other major news to report on the AIDS front?

The other interesting finding that was recently announced (PNAS) [on] historic HIV/AIDS samples collected in the 1980s and even earlier. A team of researchers from the University of Arizona has shown that the type of virus, which is found prevalent in North America, actually seems to have originated from Haiti. [It] may have come from Congo via Haitian workers from the 1960s and 70s who were working for the first Zaire government who then returned to Haiti infected. How it got from Haiti to the United States—whether it was via blood product for hemophiliacs, via gay men who were vacationing in Haiti and may have acquired sexually in Haiti, or via Haitian immigrants to the United States—these issues are not clear.

What’s interesting is how the Haitian community has reacted to this news. You had protest demonstrations in Miami. You had real outrage in the streets of Port-au-Prince. What this shows is that AIDS continues to be such a highly stigmatized disease, so politically volatile that anything that it goes to a sense of blame and judgment even if that is not the intent, which certainly is the case with the University of Arizona researchers, they had no intent of casting blame or pointing fingers. Yet it is received that way even now, more than twenty-five years since the epidemic began. And it has really opened up political sores between the United States and Haiti.