On HIV/Aids and scary-big numbers
- Ivo Vegter
- 27 Jan 2014 10:58 (South Africa)
A set of statistics, produced by UNAids, the United Nations programme that advocates for a comprehensive global response to the scourge of HIV/Aids, did the rounds on social media networks recently. I received my copy from a medical doctor, who shall remain nameless:
On the face of it, this looks terrible. Any set of numbers that isn't right-aligned on the least-significant digit looks terrible.
But jokes aside, when the public panics over fracking (zero deaths) and Fukushima (zero deaths), any infographic that shows over a million people who are actually dead must be scary. Even one sick child is an intimidating prospect for me, so a quarter of a million of them strikes terror into my very heart. And I'll add another scary-big number that isn't on that list: the total number of people living with HIV/Aids in 2012 was 35.3 million, or almost four times the number in treatment.
So, because the best psychological defence against scary monsters under the bed is denial, I described them as: “context-free scary-big numbers.”
As if to prove my point, a reader replied, “They're still pretty scary numbers. 9.7 million people accessing treatment out of a pop. of 50 million?”
I rest my case. Where in that set of numbers does it say that these represent cases in South Africa, where the population is roughly 50 million? Is it even plausible that SA treats 9.7 million people for HIV/Aids?
As it turns out, it doesn't, and it isn't. These are worldwide statistics, so the proper context is a population of over 7 billion people, not 50 million. Instead of near 20%, we're dealing with a small fraction of a percent. That makes a difference.
HIV/Aids is, of course, not insignificant, and especially not in the developing world, where HIV/Aids ranks as the third-biggest killer after coronary heart disease and lower respiratory infections, according to the World Health Organization. Worldwide, the 1.6 million Aids-related deaths ranks only sixth on the list of leading causes of death. Heart disease leads the pack, with 7 million deaths, followed by stroke, lower respiratory tract infections, chronic obstructive pulmonary disease, and diarrhoeal diseases. Aids is closely followed by lung cancer, diabetes mellitus, and road accidents. Even then, we've only covered half the causes of death, so Aids represents 3% of all deaths.
But still, hey, millions!
So where do these numbers come from? What is their context? Do they really represent what the document they were drawn from wanted to convey? Well, here it is, for your perusal: a UNAids brochure designed for the copy-paste convenience of modern media, entitled Aids by the numbers. The bit you saw was the second page of the brochure. Here is the first page:
Does that tell the same story, or does this suggest that the fight against HIV/Aids is a campaign we're actually winning?
Because not all of us are lazy, let's go to a UNAids report with some more detail, but confusingly bears the same title. In the highlights, you'll see that there has been a 33% decrease in new HIV infections since 2001, and the 2.3 million cases reported in 2012 is the lowest since the 1990s. The best news is among children, where there has been a 52% decrease in new HIV infections since 2001.
Not surprisingly, there has been a corresponding 29% decrease in Aids-related deaths in both adults and children since 2005.
There has been a 40-fold increase in access to anti-retroviral therapy since 2001, in large part because the cost of antiretroviral therapy in low- and middle-income countries has been reduced by a similar ratio: from over R100,000 per year in the 1990s to a mere R1,500 or so today.
As for South Africa, we do have 6.1 million people living with HIV/Aids, which makes us ground zero for the epidemic. However, we also have the largest treatment programme in the world, covering 2.2 million people. We have over 80% of pregnant HIV-positive women covered with anti-retrovirals, which makes South Africa one of the top-ranked countries among those in which the disease is common. The number of new HIV infections in South Africa is down by over 30% since 2004, from 540,000 to 370,000 in 2012.
Sub-Saharan Africa, where 75% of the disease's death toll occurs, is the only region in the world that counts its Aids victims in millions. Still 40% fewer people acquired HIV in 2012 than in 2001, and there were an estimated 22% fewer Aids-related deaths in the region in that time.
The UN is careful to highlight some remaining concerns, including alarming trends in risky sexual behaviours, legal and social prejudice against gay men and drug users, gender violence, and treatment gaps among children or the poor. However, these trends are not the bad news that the raw figures, printed in big red letters without any context whatsoever, would have you believe.
Phumzile Mlambo-Ngcuka used to be chairperson of the South African National Aids Council, when she was deputy president of South Africa under Thabo Mbeki. She is now the executive director of the UN Women agency.
She told Stephen Grootes at the World Economic Forum in Davos, Switzerland, that she is “incredibly proud” of the progress South Africa has made on HIV/Aids. And well might she be. These numbers, far from being alarming, are heartening.
However, we should not forget the president under which Mlambo-Ngcuka served, and the harm his dabbling in fringe conspiracy theories did to the scientific campaign against the disease. It'd be wrong to be scared witless by big red numbers, but we'd be right to feel a sense of relief that the tide is turning.
Perhaps Kgalema Motlanthe, South Africa's deputy president, put it best, at the launch of the South Africa 2012 HIV Estimates and Projections report in Durban, earlier this month: “Although these are figures we can all be proud of, we must not rest until every person who needs it is receiving HIV treatment and there are no new infections.”
We also must not rest while scary-big, context-free numbers are being passed about, by qualified medical doctors to boot, as if they contained useful information. They don't. At their most crude, they are political spin or fundraising propaganda. Often, they're ready-to-print sensationalism for a lazy media. At best, they are well-intended but meaningless trivia.
Until they provide you with some context, don't lie awake fretting about big numbers, even if they are printed in big red letters and end ominously in -illion. DM