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UNAIDS Global Report 2010: A Quick, Critical Appraisal

29 November 2010

UNAIDS Vision, image from 2010 Global Report

A quick review of the UNAIDS Report on the global AIDS epidemic 2010 as I work with students to prepare a Teach-In to commemorate World AIDS Day sparked a few thoughts that I wanted to jot down. The report, released last week, had a bit of good news, namely:

“…the AIDS epidemic is beginning to change course as the number of people newly infected with HIV is declining and AIDS-related deaths are decreasing.”

UNAIDS was quick to temper any relief these statistics might bring us, however, saying:

“…the gains are real but still fragile. Future progress wil depend heavily on the joint efforts of everyone involved in the HIV response.”

Executive Director Michel Sidibe wants to help the public to keep from being “lulled into complacency or denial.” It makes sense for an agency whose sole task is to combat HIV/AIDS to make sure that even though the numbers they publish show us that there is progress, we will continue to commit (esp. financial) resources and efforts to AIDS in the future. Cynically speaking, too much good news means UNAIDS is out of a job. What will all those technocrats do if ever there were a cure for AIDS?

Relatedly, had anyone previously seen the “zero” campaign (“Zero new infections. Zero discrimination. Zero AIDS-related deaths.”) by UNAIDS? I see that the vision was only recently approved by the governing board. I suspect UNAIDS has known for some time now that the 2010 report was going to show progress (i.e., decline in HIV prevalence and AIDS deaths) and thus had to come up with a new marketing strategy to maintain the energy from AIDS activism and support.

This is the first time I’ve read the report with such a strong feeling of cynicism and skepticism. For example, in Chapter 1 in the discussion of “A fragile progress,” the report reads:

Despite extensive progress against a number of indicators on the global scale, many countries will fail to achieve Millennium Development Goal 6: halting and reversing the spread of HIV (Figure 1.2 and Figure 1.3).

from 2010 Global Report, page 11

From which countries are these statistics drawn? And why isn’t the most important indicator of Millennium Development Goal (MDG) target 6A (HIV prevalence) also included? And really, the MDG 6 is aimed at halting or reversing the spread of HIV, which is in fact, happening in all but seven countries — so why is UNAIDS predicting “many” countries will fail to achieve that goal? Now, if they had instead pointed to the graph showing the lack of access to antiretroviral therapy (Figure 1.4), their argument would have actually been supported by the evidence: it is clear MDG 6B of universal access to antiretroviral therapy will not be met in 2010.

from 2010 Global Report, page 13

Despite this cynicism, I have some positive things to say about the report. For the first time ever, the UNAIDS document reports on sex between men as a significant factor in some African countries. Though the studies cited date back as early as 2005 (and thus preceded the 2008 Global Report), UNAIDS waited until 2010 to include discussion of men who have sex with men as a risk group in the African context.

from 2010 Global Report, page 31

And, finally, there’s something of use to those of us studying national-level response to AIDS in this new report: AIDS Scorecards. In a forthcoming paper of mine, I write about national response to AIDS, and had to rely on a limited dataset to measure efforts by a government made in response to AIDS. AIDS Scorecards are a new dataset that would allow us to measure not just government response (access to treatment, investments, human rights, gender equality measures), but also how everyday people are responding to the disease (as measured by tests of AIDS knowledge and self-reports of condom use). That’s not to say these measures aren’t flawed, but if UNAIDS continues to gather this information in the future, it could provide us another perspective from which we can ask whether governments are doing enough in the fight against AIDS (or, the cynical side of me might ask: if governments are doing too much).

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UPDATE: for those wondering how to cite the UNAIDS 2010 report, here is the citation:

UNAIDS. 2010. Global report: UNAIDS report on the global AIDS epidemic 2010. UNAIDS: Geneva, Switzerland. Accessed online [date accessed]: http://www.unaids.org/documents/20101123_GlobalReport_em.pdf.

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4 Comments leave one →
  1. ABM permalink
    29 November 2010 8:49 pm

    Thanks for the summary – I would note, though, that while you’re correct in stating that Universal Access goals will not be met for the MDGs, the increased threshold for initiating ART greatly increased the number of people eligible for treatment (denominator) while programs had to play catch up using resources that have not necessarily kept pace with what is needed to achieve Universal Access targets. I’ve also found that people living and working in some countries in Africa perceive the WHO estimates to be inflated, regardless, though we have to use the statistics available.

    • 29 November 2010 8:57 pm

      You are right. For those who don’t know, the World Health Organization recently increased the threshold of CD4 cell count in determining eligibility/access to treatment (which means more people now are eligible for treatment who were previously considered not sick enough). The new guidelines were made on the heels of research findings that initiating treatment earlier reduced morbidity and mortality.

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