- Aiding and Abetting:Why Western fundraising fails to stop the spread of AIDS
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International organizations have repeatedly deceived donors to ensure ever more funding for AIDS-relief efforts. In the mid-1990s, large NGOs and U.N. agencies began to overestimate infection rates and create heart-rending but misleading storylines to imply that general populations across the world were on the verge of HIV outbreaks. [End Page 109]
In some ways, the strategy worked. Billions of dollars flowed to these groups, and they helped treat millions of individuals with AIDS. But their false narratives distorted the world's understanding of the crisis. While pharmaceutical companies and giant nonprofits benefited, money was steered away from programs where it could have been most effective.
Epidemiologist Elizabeth Pisani, a former consultant to groups like UNAIDS and the Centers for Disease Control and Prevention, helped craft some of these reports designed to dupe the public. In her book, The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS, she writes that she contributed to a UNAIDS publication that promoted the "innocent wives" thesis, which argues that the virus spreads beyond high-risk groups primarily by promiscuous men having sex with their faithful spouses. The report stated, "The virus is firmly embedded in the general population, among women whose only risk behavior is having sex with their own husbands."
This generalization came from one small study in Pune, India. Women who participated in the study were tested for HIV and other STDs and then were given questionnaires to gather demographic and sexual behavior information. The conclusion that women were likely being infected by their adulterous husbands, though, is based on skewed data; the sample was entirely made up of women who visited STD clinics. Their situation doesn't necessarily represent the "general population." But Pisani and her colleagues deliberately wrote the document to suggest that HIV was harming scores of Indian wives. As she puts it:
We weren't making anything up. But once we got the numbers, we were certainly presenting them in their worst light. We did it consciously. I think all of us at that time thought the beat-ups were more than justified, they were necessary. We were pretty certain that neither donors nor governments would care about HIV unless we could show that it threatened the "general population."
The organizations that Pisani worked for constructed emotional stories and often ignored statistical validity. In one case, an already flawed study suggested that 8 million Indonesian men buy sex every year. Using the innocent-wives theory, Pisani and her colleagues intimated that this could lead to millions of infected spouses. In reality, their own estimates showed only about 16,000 Indonesian women were potentially at risk in the scenario, since most of these men had neither a wife nor HIV.
Despite evidence demonstrating that women in some countries infect their husbands about as often as their husbands infect them, the innocent-wives narrative is backed by compelling anecdotes of women being wronged by devious, philandering men. Stories of victims elicit strong emotions and can open checkbooks for AIDS groups, marketing firms, condom producers, and pharmaceutical companies. Even though reality differs from the accounts of cheating husbands or a "disease of poverty" best curbed with more outside resources, it's in the interest of AIDS groups to sell stories of helplessness.
Regarding how the international AIDS relief community has functioned in the last decade, Daniel Halperin, a former senior HIV prevention and behavior change adviser for USAID, and Craig Timberg, the former Johannesburg bureau chief for The Washington Post, write: [End Page 110]
More alarm, and more politically appealing victims, meant more programs, more staff, more money. … If AIDS was not just a public health problem but also a substantial development issue, the World Bank and the United Nations Development Program had a claim to rival the WHO's original one. If its list of victims included children, so did UNICEF. Soon UNAIDS became like a snowball tumbling downhill.
Overstating the global AIDS threat has helped keep money pouring in. By the late 1990s and early 2000s, it...