Professor Gordon Stewart
Emeritus Professor of Public Health, Glasgow University
In the early 90's Professor Gordon Stewart correctly predicted the spread of AIDS based on a risk hypothesis rather than a sexually infectious hypothesis. His predictions for the UK and Africa have proved correct.
Below, is an extract from 'Positively False' by Joan Shenton describing the way Professor Stewart was ignored by the medical establishment at the time.
(Following this, is a recent article in the Washington Post - April 6, 2006, lamenting the grossly exaggerated figures for AIDS in Africa over the past 15 years.)
Extract from 'Positively False' by Joan Shenton
Then in October 1988 the official government Cox Committee which was advising the then Health Minister, David Mellor, reported its predictions. These were set within wide limits and predicted between 1590 and 15440 new cases per year to give a cumulative total of 8000 to 34077 cases by the end of 1992. None of this happened. By the beginning of 1990 there was a cumulative total (since 1982) of 2800 registered AIDS cases (142 allegedly from heterosexual contact) and by 1992 a total of 6929 cases. The Cox Committee had estimated a mean figure of 17,125 (8000 - 34077) - an overestimate of 147%!
David Mellor a few years later conceded that too much public money had been spent on AIDS awareness campaigns directed at heterosexuals, but claimed he had felt pressured because of the alarming predictions of spread the Committee had come up with. He had, he felt, been sorely ill-advised and would be prepared to say so in any future documentary we might be making. [28]
During this period, Professor Gordon Stewart had been making strong efforts to get an article printed in which he based his predictions for AIDS on risk behaviour rather than the sexually infectious hypothesis. He maintained that even if Duesberg's arguments on HIV were laid aside, the epidemiological evidence did not support the idea that HIV was a sufficient cause of AIDS. Stewart is an eminent scientist and epidemiologist, famous for his work cleaning up early penicillin to get rid of allergenic residues, and developing the new penicillins. For many years he was Professor of Public Health at Glasgow Unversity.
Stewart wrote to the Medical Research Council and to the Department of Health suggesting that the predictions were dangerously exaggerated when compared with trends since 1982. They did not respond. He then wrote to the Royal Society which expressed interest initially but held on to Stewart's paper until 1994 when they finally rejected it. Communications with the Nature, the BMJ, the New England Journal of Medicine and other journals were also rejected until the Lancet finally published a short letter from Stewart in 1993, accompanied by a cautious editorial comment. [29]
Looking back on his figures, which strongly criticised the Cox Committee's position (presented by various invited experts at the Royal Society's Symposium in 1989), we find that Stewart was extraordinarily accurate. His predictions made in 1989 (which he had conveyed early in 1990 to the MRC and to the Royal Society) of 1254 cases in the UK in 1991 could not have been closer. The actual total of registered cases was 1275. Stewart's overall predictions for the decade 1982-92 were also extremely close. He predicted 6540 cases and the actual total was 6929. [30] Remember that Cox had quoted 12750 or more for planning in this period.
Professor Stewart had been one of our scientific advisers through many of our science and medical programmes for television. We were in close touch with him when he made his predictions in 1989 and read all of his correspondence with the different science journal editors. He was deeply frustrated. He was the only senior public health expert who offered a learned and detailed critique of the Government's position, and not a single medical body or journal would give him an inch of space.
He says, "The blank refusal of all the main medical societies and colleges, and nearly all the journals, to face the facts about AIDS is scandalous, and is probably the chief reason for the failure to develop a rational strategy to prevent a continuation of spread in the main risk groups and third world countries." [31]
Stewart also says, "Apart from the accuracy (and mathematical simplicity of) my predictions, the main implications are (1) that the hypothesis that HIV is the necessary and sufficient cause of AIDS is not supported on epidemiological grounds; (2) that AIDS is not spreading except in groups engaging in or subjected to high risk behaviour; and (3) that there is no evidence in the USA, UK and northern Europe at least of any appreciable spread by heterosexual transmission or by vertical transmission to infants except from mothers in high risk groups." [32]
Stewart's projections for this period have been analysed by statistician Barrie Craven PhD, of the University of Northumbria. Together with other data from official sources Craven has shown the absurdity of the pattern of expenditure on AIDS prevention across the world. He has also highlighted the questionable estimates for the spread of AIDS in third world countries and pointed to the implications of his findings on future expenditure on AIDS.
However, the censorship surrounding anyone challenging HIV meant that Stewart's views were completely ignored by the establishment.
How AIDS in Africa Was Overstated: Reliance on Data From Urban Prenatal
Clinics Skewed Early Projections
By Craig Timberg
Washington Post Foreign Service
Thursday, April 6, 2006; A01
KIGALI, Rwanda -- Researchers said nearly two decades ago that this tiny
country was part of an AIDS Belt stretching across the midsection of Africa,
a place so infected with a new, incurable disease that, in the hardest-hit
places, one in three working-age adults were already doomed to die of it.
But AIDS deaths on the predicted scale never arrived here, government health
officials say. A new national study illustrates why: The rate of HIV
infection among Rwandans ages 15 to 49 is 3 percent, according to the study,
enough to qualify as a major health problem but not nearly the national
catastrophe once predicted.
The new data suggest the rate never reached the 30 percent estimated by some
early researchers, nor the nearly 13 percent given by the United Nations in
1998.
The study and similar ones in 15 other countries have shed new light on the
disease across Africa. Relying on the latest measurement tools, they portray
an epidemic that is more female and more urban than previously believed, one
that has begun to ebb in much of East Africa and has failed to take off as
predicted in most of West Africa.
Yet the disease is devastating southern Africa, according to the data. It is
in that region alone -- in countries including South Africa, Botswana,
Swaziland and Zimbabwe -- that an AIDS Belt exists, the researchers say.
"What we know now more than ever is southern Africa is the absolute
epicenter," said David Wilson, a senior AIDS analyst for the World Bank,
speaking from Washington.
In the West African country of Ghana, for example, the overall infection
rate for people ages 15 to 49 is 2.2 percent. But in Botswana, the national
infection rate among the same age group is 34.9 percent. And in the city of
Francistown, 45 percent of men and 69 percent of women ages 30 to 34 are
infected with HIV, the virus that causes AIDS.
Most of the studies were conducted by ORC Macro, a research corporation
based in Calverton, Md., and were funded by the U.S. Agency for
International Development, other international donors and various national
governments in the countries where the studies took place.
Taken together, they raise questions about monitoring by the U.N. AIDS
agency, which for years overestimated the extent of HIV/AIDS in East and
West Africa and, by a smaller margin, in southern Africa, according to
independent researchers and U.N. officials.
"What we had before, we cannot trust it," said Agnes Binagwaho, a senior
Rwandan health official.
Years of HIV overestimates, researchers say, flowed from the long-held
assumption that the extent of infection among pregnant women who attended
prenatal clinics provided a rough proxy for the rate among all working-age
adults in a country. Working age was usually defined as 15 to 49. These
rates also were among the only nationwide data available for many years,
especially in Africa, where health tracking was generally rudimentary.
The new studies show, however, that these earlier estimates were skewed in
favor of young, sexually active women in the urban areas that had prenatal
clinics. Researchers now know that the HIV rate among these women tends to
be higher than among the general population.
The new studies rely on random testing conducted across entire countries,
rather than just among pregnant women, and they generally require two forms
of blood testing to guard against the numerous false positive results that
inflated early estimates of the disease. These studies also are far more
effective at measuring the often dramatic variations in infection rates
between rural and
urban people and between men and women.
UNAIDS, the agency headed since its creation in 1995 by Peter Piot, a
Belgian physician, produced its first global snapshot of the disease in
1998. Each year since, the United Nations has issued increasingly dire
assessments: UNAIDS estimated that 36 million people around the world were
infected in 2000, including 25 million in Africa. In 2002, the numbers were
42 million globally, with 29 million in Africa.
But by 2002, disparities were already emerging. A national study in the
southern African country of Zambia, for example, found a rate of 15.6
percent, significantly lower than the U.N. rate of 21.5 percent. In Burundi,
which borders Rwanda in central East Africa, a national study found a rate
of 5.4 percent, not the 8.3 percent estimated by UNAIDS.
In West Africa, Sierra Leone, just then emerging from a devastating civil
war, was found to have a national prevalence rate of less than 1 percent --
compared with an estimated U.N. rate of 7 percent.
Such disparities, independent researchers say, skewed years of policy
judgments and decisions on where to spend precious health-care dollars.
"From a research point of view, they've done a pathetic job," said Paul
Bennell, a British economist whose studies of the impact of AIDS on African
school systems have shown mortality far below what UNAIDS had predicted.
"They were not predisposed, let's put it that way, to weigh the
counterevidence. They were looking to generate big bucks."
The United Nations started to revise its estimates in light of the new
studies in its 2004 report, reducing the number of infections in Africa by
4.4 million, back to the total four years earlier of 25 million. It also
gradually decreased the overall infection rate for working-age adults in
sub-Saharan Africa, from 9 percent in a 2002 report to 7.2 percent in its
latest report, released in November.
Peter Ghys, an epidemiologist who has worked for UNAIDS since 1999,
acknowledged in an interview from his office in Geneva that HIV projections
several years ago were too high because they relied on data from prenatal
clinics.
But Ghys said the agency made the best estimates possible with the
information available. As better data emerged, such as the new wave of
national population studies, it has made revisions where necessary, he said.
"What has happened is we have come to realize that indeed we have
overestimated the epidemic a bit," he said.
On its Web site, UNAIDS describes itself as "the chief advocate for
worldwide action against AIDS." And many researchers say the United Nations'
reliance on rigorous science waned after it created the separate AIDS agency
in 1995 -- the first time the world body had taken this approach to tackle a
single disease.
In the place of previous estimates provided by the World Health
Organization, outside researchers say, the AIDS agency produced reports that
increasingly were subject to political calculations, with the emphasis on
raising awareness and money.
"It's pure advocacy, really," said Jim Chin, a former U.N. official who made
some of the first global HIV prevalence estimates while working for WHO in
the late 1980s and early 1990s. "Once you get a high number, it's really
hard once the data comes in to say, 'Whoops! It's not 100,000. It's 60,000.'
"
Chin, speaking from Stockton, Calif., added, "They keep cranking out numbers
that, when I look at them, you can't defend them."
Ghys said he never sensed pressure to inflate HIV estimates. "I can't
imagine why UNAIDS or WHO would want to do that," he said. "If we did that,
it would just affect our credibility."
Ghys added that studies now show that the overall percentage of Africans
with HIV has stabilized, though U.N. models still show increasing numbers of
people with the virus because of burgeoning populations.
Many other researchers, including Wilson from the World Bank and two
epidemiologists from the U.S. Agency for International Development who wrote
a study published last week in the Lancet, a British medical journal,
dispute that conclusion, saying that the number of new cases in Africa
peaked several years ago.
Some involved in the fight against AIDS say that tallying HIV cases is not
nearly as important as finding the resources to fight the disease. That is
especially true now that antiretroviral drugs are more affordable, making it
possible to extend millions of lives if enough money and health-care workers
are available to facilitate treatment.
"It doesn't matter how long the line is if you never get to the end of it,"
said Francois Venter, a South African doctor and head of Johannesburg
General Hospital's rapidly expanding antiretroviral drug program, speaking
in an interview in Johannesburg.
But to the researchers who drive AIDS policy, differences in infection rates
are not merely academic. They scour the world looking for evidence of
interventions that have worked, such as the rigorous enforcement of condom
use at brothels in Thailand and aggressive public campaigns that have urged
Ugandans to limit their sexual partners to one.
Programs deemed successful are urged on other countries and funded lavishly
by international donors, often to the exclusion of other programs.
Rwanda, a mountainous country of about 8.5 million people jammed into a land
area smaller than Maryland, has relied on approaches similar to those used
in Uganda, and may have produced similar declines in HIV. UNAIDS estimated
in 1998 that 370,000 Rwandans were infected, equal to 12.75 percent of all
working-age adults and a substantial percentage of children as well. Every
two years since, the agency has lowered that estimate -- to 11.2 percent in
2000, 8.9 percent in 2002 and 5.1 percent in 2004.
Dirk van Hove, the top UNAIDS official in Rwanda, said the next official
estimate, due in May, would show an infection rate of "about 3 percent," in
line with the new national study. He said the U.N. estimate tracked the
declining prevalence.
Rwandan health officials say their national HIV infection rate might once
have topped 3 percent and then declined. But it's just as likely, they say,
that these apparent trends reflected nothing more than flawed studies.
Even so, Rwanda's cities show signs of a serious AIDS problem not yet tamed.
The new study found that 8.6 percent of urban, working-age women have HIV.
Overall, officials say, 150,000 Rwandans are infected, less than half the
number estimated by UNAIDS in 1998.
Bruno Ngirabatware, a physician who has treated AIDS patients in Kigali
since the 1980s, said he has seen no evidence of a recent decline in HIV
infection rates.
"There's lots of patients there, always," he said.
C 2006 The Washington Post Company
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