Don’t get spun!

How to spot data

torturing, and other
tricks of the trade

Elizabeth Pisani
Vienna, 2010
 A tale of two epidemics
Percent of adults infected with HIV, 2007
(Source: UNAIDS, national goverments)

Swa z
ila nd
Swaziland 33
Bots
wana
Botswana 24
L es
o tho
Lesotho 23
Sub-Saharan Africa:
Zim
babwe
Zimbabwe 20 * 10% of world population
Na m
ibia
Namibia 20
South Afric a
South Africa 19 * 66% of HIV
Za m
bia
Zambia 17
Moz
ambiq ue
Mozambique 16
* 72 % of AIDS deaths 2005
Mala wi
Malawi 14
CAR
CAR 11
SS Afric a
SS Africa 6

Carib bean
Caribbean 2
Am
eric as
Americas 0.6
Euro pe
Europe 0.5
As
ia P acific
Asia Pacific 0.4
No rth Afric a and Mid dle Eas
t
Med Crescent 0.2

0 10 20 30 40 50 60 70 80 90 100
The other twenty million
 The naked truth
HIV is a virus that spreads largely among people who have
unprotected sex with several partners or share needles
in any three-month period.

Globally, those most likely to do that are:

– Gay men
– Men in jail
– Drug injectors Vote-loser
No money
– People who sell and buy sex Stigmatising

– East and Southern Africans

Racist
 We needed to “repackage” the
problem
The money argument:
Spend now, save later

• The votes argument:

Prevent HIV in “vulnerable populations” now, save
“innocent women and children” later
Subtext: it could happen to YOU!
More sex = more HIV
 If “everyone is at risk”…
• The AIDS mafia is happy
(We get more money)
• Governments are happy
(They don’t have to deal with “ick” groups)
• UN and NGOs are happy
(They get cash regardless of mandate)
• Activists are happy
(HIV is less stigmatised)
• HIV is happy
(it can go on spreading)
 Cambodia’s epidemic is
“feminising” and “generalising”
 Look again.
P ro p o rtio n o f n e w H IV in fe c tio n s in d iffe re n t p o p u la tio n s
(S o u rc e : C a m b o d ia E s tim a te s W o rk in g G ro u p , u s in g A s ia n E p id e m ic M o d e l)

3 0 ,0 0 0

2 5 ,0 0 0
Number of people newly infected with HIV

2 0 ,0 0 0

1 5 ,0 0 0

1 0 ,0 0 0

5 ,0 0 0

-
1986 1991 1996 2001 2006 2011 2016

C lie n ts S e x w o rk e rsH u s b a n d s o f c u rre n t/fo rm e r s e x wWoiv

rkeesrso f c u rre n t/fo rm e r c lie n
It’s not just in developing countries
Games (PR) people play:
Relative measures
 Implying causality
• Half of all new infections are in young
people, therefore we need HIV prevention
programmes for young people

• African countries with the highest condom

rates also have the highest HIV rates.
Clearly condoms can’t be considered as
the first line of defense against HIV
– Bill Bennet, former US minister for education
 Parts of the truth:
HIV & GDP per capita—Global

35%

30% Slide 17
 HIV IS a “development problem”
In Africa, there’s more HIV in the richest countries
Adult HIV prevalence by per capita GNP.
The size of the circle represents absolute numbers of people infected

35%

Source: World Bank

 Unclear definitions

• Eight out of 10 Americans say AIDS is

important. In India 2/3 say it is more
important than other issues the world
faces. In sub-Saharan Africa, 57% say it is
just as important as other issues
 Key questions: data
• Who is in the denominator
(who does this sample represent?)
– In Bali, an NGO says 21% of sex workers are
infected with HIV. The Balinese government says it
is 7%.
• Who is in the numerator
(who meets the criteria for this measure?)
– Seven out of 10 schoolgirls have boyfriends, and
only 10% always use condoms
• Who is in the final analysis
 Key questions: politics

• Who did this study? And who paid for it?

• Who am I talking to?
• Why are they telling me this?
• What are they not telling me?
• Who would disagree with them?
For all the “socio-economic determinants”,
HIV is just a (not very) infectious disease

For a new HIV infection you need:

• A person infected with HIV
(and infectious)
• A person NOT infected with HIV
(and susceptible)
• An exchange of body fluids
 Circumcision
Abstinence (Lubricant)
Partner reduction (Microbicides/Vaccine)
Age and sero-sorting PMTCT/PEP/(PrEP)
STI treatment

CONTACT EXPOSURE
TRANSMISSION
Will they have Will body fluids
Who is HIV sex or inject be exchanged? Is the HIV
uninfected? uninfected
drugs together?
susceptible?
HIV HIV
uninfected uninfected

Is the HIV
Who is HIV infected
HIV HIV infectious?
infected? infected infected

Testing Condoms
Methadone Sterile needles ARVs
Surveillance STI treatment
Blood screening
Ceasarian
Source: Pisani, Back to Basics, 2006
 In the field of AIDS,
treatment IS prevention
-Senator Tom Coburn, June 2008
Behaviour