Flat Earth, Meet AIDS Denial.

The Daily Dispatch on the 26th of January bore a story which, if true, was immensely heartening. No wonder that it was on the front page; the wonder that it was below the fold. The headline was “HIV testing in men increases”, and the story was that a person called Dr Saul Johnson, managing director of Health and Development Africa, said that HIV testing had increased in twelve months from 24% to 60% among men. This was the Second National HIV/AIDS 2009 survey, based on a sample of 9 728 people. Other articles in other newspapers added further information that there had been an even higher increase in the use of condoms, (although Johnson bewailed the fact that married people were not using condoms enough) and a comparable drop in the number of people having multiple partners. Johnson attributed the change to “awareness campaigns”.
This is wonderful news which at last shows that the country is successfully challenging the AIDS crisis. The only effective way to reduce the spread of HIV is to wear condoms. Likewise, a major obstacle to challenging AIDS is to take personal responsibility for one’s status, and an important symbol of that is to take an HIV test. Also, of course, if people are faithful to a single partner, they will not spread the disease beyond that couple. So it seems that we have good reason to believe that AIDS is not going to be a massive problem in future, because all these vectors for its transmission are being choked off.
In fact, since the situation is obviously under control, the Creator now feels free to go out and have lots of unprotected anal sex with numerous people without telling the partner . . .
OK, that’s not exactly a joke. It’s an application of the notion that a newspaper report of AIDS denialism makes people into AIDS denialists; the notion, therefore, that all questions about AIDS should be censored lest the wrong ideas be given. The point is that good news can also generate the wrong ideas. But it is still good news.
Or is it?
Puzzlingly enough, different news outlets seem to have different stats. MSN South Africa says that whereas four years back 17% of men tested for HIV, the figure is now 32%. This is plausible as a change and as a figure, but it disagrees with the 60% claimed by Johnson in the Dispatch. News24 agrees with the 32% figure, but adds that 75% of men between 16 and 19 tested last year. This is interesting, if true, but it suggests that there are a lot of figures to play statistical games with.
Anyway, a 150% increase in twelve months is gigantic. That relatively low level of HIV testing had been stable for a long time. 60% of all males being tested in a year is a high level of testing. The Creator had occasion to go into a VCT clinic in the local town recently, assisting an HIV+ friend. There were no queues outside. There were a few people inside. Two thirds of these were women (it’s partly a paediatric clinic). This VCT clinic particularly deals, of course, with people who are already HIV+, and therefore a lot of the clientele would have been such people coming back for medication or advice. They definitely weren’t all there for tests. Where were all those men? Where were they hiding?
The Creator happens to know how many people are getting antiretrovirals in the Creator’s own village; it’s less than 1% of the male population. The village happens to have a VCT centre; most do not. It’s fantastically unlikely that this village has reached more than a fraction of those in need, and it’s also the case that the clinic is not crowded with males seeking testing, either. In villages which lack such centres there’s not even the option.
Now, that is only a limited sample, but it’s surely an indication. If there really had been so mighty an increase in testing this year, it would have become evident. There would be queues outside every clinic. There aren’t. It seems likely, then, that the claim is bogus.
The same, empirically, seems true about condoms. In the Creator’s knowledge, almost the only people who seem to take full advantage of the free condoms provided by the government are prostitutes. Most people don’t know how to get them (and most people don’t go to clinics unless they are ill, in which case they are rarely feeling randy enough to stock up on rubber johnnies). Besides, we know that the government’s purchase of condoms is simply inadequate to deal with the sex lives of fifty million people. (At one roger per night per couple, that works out at ten billion condoms a year, more than 100 times the size of the government’s annual buy.) Meanwhile, if everybody were really buying condoms, there would be condom palaces on every streetcorner and people would be charging off with shopping-baskets full. They aren’t. Moreover, condoms are pretty expensive; there are places you can buy a whore for less than the price of a commercial condom.
So, it would seem that Dr. Johnson is entirely mistaken about what people are doing with their johnsons.
But how can this be? Well, consider the fact that there is no way of determining whether people have had HIV tests (doctors aren’t supposed to release that kind of information) and there is certainly no way of telling whether people are using condoms. So what kind of investigation was this? Essentially, it meant asking people “Do you test, do you use condoms, do you screw around?”. Johnson’s survey was not a test of what people were doing, it was, at best, a test of what people wanted other people to think that they were doing. Unfortunately, empirical examination suggests that there is a discrepancy between what people say, and what they do.
Yet Johnson is not saying “There has been a dramatic increase in people claiming to go for HIV testing”. One wonders why not, because such a dramatic increase, while it would not be any real guide to the AIDS situation, might indeed indicate a change in public attitude. Such a change in attitude might, over time, lead to a change in behaviour which would be a good thing.
You might ask why, too, there’s such insistence on the value of “awareness campaigns”. In the last year there has been no significant improvement in such campaigns. There are no new billboards, nor new posters; a handful of fliers and a couple of not very convincing radio advertisements seems to be the bulk of what’s happened. How could such insignificant activity be seen as progenitor of a gigantic transformation of social behaviour? Johnson, however, says that 33% of the population at large use condoms, but 50% of the population who are aware of “communication programmes” do so. This, in spite of the obvious fact that condoms are not the core focus of such programmes.
But then, Johnson coyly fails to mention that he is in charge of the government’s privatised AIDS publicity, and has been since 2001 or thereabouts. This publicity is funded partly by the government, but mostly by the United States, via USAID and various NGOs and quangoes. It is run by a private company, most of whose leadership figures are corporate specialists rather than doctors or PR experts. In other words, Johnson’s survey is essentially quality control on Johnson’s own work, which is very convenient.
There’s more, of course. The government needs some kind of success in the healthcare sphere. They have just proposed privatising the central medication depot in the Free State (allegedly the location of the problems in providing antiretrovirals in that province, which seems an implausible accusation) which essentially acknowledges a problem. Is it possible for them to locate some good news? And, if there is no easily-located good news, can some be manufactured?
Until recently, the press was simply not prepared to print good news about AIDS. Any good news might have been seen as support for Mbeki and his Health Minister, and this was unacceptable to the press (whether out of ideological fervour or because all the other sheep were trotting in the same direction). Now, of course, the press is simply confused. Shall we print good news without question, because Mbeki is gone? Shall we print good news without question because our bosses like Zuma? Or shall we go to the trouble of asking questions, or even doing the most perfunctory check on a story?
Evidently not. Instead, what we are getting is self-contained happytalk news, where the makers of the news assess the factuality of the news and then determine how the news will be run. All that is necessary is for the people reading the news not to think about what it means. This is precisely what Nick Davies was talking about when he warned us in Flat Earth News.

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One Response to Flat Earth, Meet AIDS Denial.

  1. Nokwindla says:

    Best blog and blogger in the whole of RSA! Thank you very much. I suggest you write a book about RSA politics 1985 to 2010.

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