Heterosexual AIDS Pandemic Not Expected

I am posting this news story so our anonymous commenters can take it the wrong way. You know that the African continent is being decimated by an AIDS epidemic that hits the heterosexual population mostly. HIV has spread to the straight population in the US and Europe, but still predominantly hits gay men and IV drug users. Some early models had predicted that it would explode among heterosexuals in our society, but according to this story in The Independent that isn't now expected to happen.

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

I think their use of the word "admits" here is a little strange. I guess that's because the earliest models had predicted otherwise. I don't think there is any embarrassment though when a researcher finds that some parameters have to be adjusted as the data come in.

Hmm, interesting...

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.

This story is a little confusing, in that it talks about two different populations of people. They talk like AIDS won't hit the heterosexual population, but they mean the heterosexual population outside Africa. The numbers in the preceding paragraph include the African continent, where heterosexual sex is the main vehicle of propagation of the virus. In the countries where AIDS mainly hits men having sex with men, drug users, and sex workers, it has not killed more people that "all wars and conflicts combined." So it is important to be a little careful with the conclusions you draw here.

Skipping through this story ...

[de Cock:] "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...

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?"

Personally, I am not finding it amazing that there is more AIDS in Washington DC than in North Dakota, how about you?

I am posting this story provocatively. I know that for some readers, every negative stereotype will be activated by the finding that maybe HIV isn't going to spread through the heterosexual population outside of Africa. Every demographic group has its bane, whether it's alcoholism or prostate cancer or high blood pressure or whatever, the fact is that being alive is a health risk. In our society, because of the way HIV was introduced and because of the long latency between when you get infected and when symptoms appear, and because physicians weren't watching for it when it became prevalent in the eighties, it got a stronghold in the gay male population and that group has had to struggle with it ever since. If you remember, the first groups identified were gay men and Haitians.

This is good news, of course. The epidemic has been devastating on the African continent, and terrible elsewhere but it has not reached the proportions -- imagine a country where forty percent of people are infected -- in our society that has been seen in other places.