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Last Updated: Saturday, 3 February 2007, 02:01 GMT
Expert doubts widespread HIV risk
Intravenous drug user
Intravenous drug users are a key high-risk group
HIV/Aids campaigners are circulating "misconceptions" about who is at risk, a former World Health Organization expert has warned.

Dr James Chin was head of a WHO Global Programme on Aids unit from 1987-1992.

In a new book, he says people in the general population outside Africa are unlikely to contract HIV/Aids, as it is restricted to certain high-risk groups.

Campaigners have promoted a message of safer sex which involves the use of condoms for protection.

UK experts said Dr Chin's views were inaccurate, and misrepresented current thinking among HIV/Aids bodies.

He is overstating his case
Lisa Power, Terrence Higgins Trust

Dr Chin says HIV prevalence is low in most populations throughout the world and can be expected to remain low.

He believes this is not because of effective HIV prevention work, but because infection rates are limited by the numbers in groups whose behaviour puts them at high risk.

Dr Chin says it is only in sub-Saharan Africa, where unprotected sex outside marriage is common, that the risk of heterosexual HIV transmission is high.

In other parts of the world, he says HIV is seen only in men who have sex with other men, intravenous drug users and female sex workers.

And he says that, unless the clients or partners of people in these groups also indulge in high-risk behaviour, the virus will not spread.

'Difficult to transmit'

However Dr Chin says these facts have been "minimised and ignored" by UNAids and Aids activists because it is "politically and socially more acceptable" to say HIV risk behaviours are present in all populations.

Writing in "The Aids Pandemic", Dr Chin says: "These activists do not want to further stigmatise persons or population groups who have such high risk levels of HIV risk behaviours and who are already marginalised.

"By refusing to accept the fact that HIV is very difficult to transmit sexually without the highest levels of sexual risk behaviours, Aids programmes have avoided labelling some populations as being more promiscuous than others.

"It is a much more socially and politically correct public health message to say that sexual promiscuity exists in all populations and thus the risk of epidemic heterosexual HIV transmission to the general public, or to ordinary people can be prevented only by aggressive programmes directed at the general population, and especially to youth."

He cited studies which showed the risk of someone in the general population of contracting HIV from any single sexual act was, at the highest estimate, one in 1,000.

And he says the failure to recognise this means that scarce public health resources in countries where HIV prevalence is low are being wasted on prevention programmes being targeted at the public, when it is the high-risk groups who should be targeted.

'Disservice'

Dr Purnima Mane, director of policy evidence and partnerships at UNAids said: "Without having access to the full text of the book, it is very difficult for UNAids to comment on it."

But she said: "The Aids response has always invited a high-level of debate and discussion. UNAids welcomes this debate and stands by its scientific approach.

"Twenty-five years into the Aids epidemic has shown the world how the epidemic has continued to evolve and how the response must also evolve.

Dr Mane added: "UNAids data is not influenced by political or fundraising agendas."

Lisa Power, head of policy at the UK's Terrence Higgins Trust said Dr Chin's views may have been accurate 10 to 15 years ago, but were not true now.

"He is overstating his case. Sub-Saharan Africa is not the only place to have heterosexual epidemics and most AIDS activists no longer espouse a one-size-fits-all approach to HIV prevention work.

"Some authorities are wrong to misrepresent their HIV epidemiology in order to maximise public interest in the issue.

"But Chin is doing a similar disservice by misrepresenting current HIV planning and thinking in order to maximise public interest in his book."

Ms Power said there was a need for campaigns targeted at high-risk groups and more general information to ensure better public understanding of HIV and sexual health in order to tackle the stigma surrounding the disease."

The Aids Pandemic: the collision of epidemiology with political correctness is published by Radcliffe Publishing at 27.50.


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