45

Public Health, Public Relations,

and AIDS
After nearly two decades of warnings about the impending heterosexual AIDS
epidemic, none has materialized. In contrast to the dire predictions and despite
widespread HIV testing, AIDS has remained almost exclusively confined to
the original risk groups.172 Even within risk groups, the numbers have never
reached expected proportions and have been quietly diminishing for over five
years. As AIDS in America has failed to live up to its terrifying reputation, our
attention is directed to other parts of the world where harrowing estimates go
unchecked and vastly exceed actual diagnoses.173
Information from the US Centers for Disease Control reveals that the disparity
between official AIDS reports and actual AIDS data began in 1987. At that time,
public health agencies elected to ignore their own findings in favor of promoting
the notion that “everyone is at risk for AIDS.”174,175 Although epidemiology
indicated this claim was not and would probably never be true, marketing
research concluded that widespread support for AIDS would be impossible
unless AIDS was considered a widespread health threat. Responding to Gallup
Polls and PR studies, the CDC decided on a strategy that disregarded the facts
in order to “mobilize support for public funding.”175 As CDC virologist Dr.
Walter Dowdle admitted, “As long as this was seen as a gay disease, or even
worse, a disease of drug abusers, this pushed the disease way down the ladder”
of funding priorities.
The CDC’s early decision to overestimate AIDS and magnify the risks launched
one of the most successful advertising campaigns in history. In 1986, the
majority of Americans did not feel at risk for AIDS; by 1988 more than two-
thirds thought a full scale epidemic was likely, and by 1991, most believed that
even married couples faced a substantial risk of contracting AIDS.175 Federal
tax dollars allocated to AIDS doubled the first year of the CDC ad campaign,
and by the early 90s had topped $1 billion a year.
While concern and support for AIDS has multiplied and spread among
millions of Americans, AIDS itself has not. This discrepancy has required a
careful management of information and the need for constant advertisements,
predictions and news reports that perpetuate ideas about AIDS that are out
of sync with reality. Instead of revealing hard numbers and cold facts, most
public health and AIDS organizations, along with the media, dispense reports
that employ misleading percentages, alarming estimates, or cumulative totals
for AIDS that disguise the realities of the epidemic.
The use of cumulative totals makes it possible to cite ever-growing
numbers for AIDS even as AIDS is actually declining. Until 1997, despite
steady decreases that began four years earlier, AIDS in America was almost
universally described as an increasing problem, an image supported by the
use of cumulative case numbers. For example, the total of new adult AIDS
cases in the US in 1996 was 5,000 less than in 1995, but by adding the 1996
46 What If Everything You Thought You Knew About AIDS Was Wrong?

cases to the total number of cases reported since 1981, the decline of 5,000
was portrayed as an increase.176
Percentage calculations can turn drops into rises and are frequently used to
make small numbers appear impressive. For example, in 1998 the number of
new cases of AIDS among women decreased by more than 2,000, but at the
same time, the percentage of total cases that women represent increased by
1%. This 1% difference in percentage is used to make the claim that AIDS is
increasing among women.176 The warning that heterosexuals are the fastest
growing AIDS risk group is based on this same misleading use of percentages.
In fact, cases of AIDS have been declining in all risk groups since 1993.177
Such statistical sleight of hand is not exclusive to the US media or American
AIDS organizations. In Canada, a nation with an extremely low incidence of
AIDS, government AIDS officials and the media play up the few cases there are
and often perform their own magic with the numbers. For example, in 1995
new AIDS diagnoses among Canadian women totaled 175. This figure dropped
to 165 in 1996, and then to 88 in 1997. News reports did not celebrate these
decreases or the fact that in a country with some 15 million females, only 88
women were diagnosed with AIDS that year. Instead, the increased percentage
of cases among women, from 8.8% of all AIDS cases in 1995 to 15.4% of AIDS
cases in 1997, led Canada’s Laboratory Centre for Disease Control (LCDC) to
pronounce that women with AIDS made up “the highest proportion [of AIDS
cases] observed since monitoring of the epidemic began.”178
Estimates that can make anything seem possible are commonly used in AIDS
news reports and advertising campaigns, and although the word “estimate” is
crucial to qualifying claims, it is often omitted from ads and media reports.
To take just one example, advertisements for the “Until There’s A Cure”
AIDS bracelet use blood-red capital letters to proclaim “16,000 people a
day are introduced to HIV by testing positive.”179 It is necessary to contact
the bracelet company in order to learn that the figure cited in the ad is an
approximation based on global WHO estimates which are not even based on
HIV test results.180
WHO estimates for AIDS in developing areas of the world such as Africa are the
basis for many news reports. Although these estimates bear little resemblance
to actual numbers of AIDS cases, the discrepancy might understandably
be explained by the need to estimate a certain amount of AIDS cases in
undiagnosed persons. However, the ratio of diagnosed cases to estimated cases
inexplicably varies among African nations, ranging from nine estimated AIDS
cases for every one case diagnosed, to as high as 69 for each single case.181
For example, the WHO ratio for AIDS in Zimbabwe is 10/1, while the ratio
of 48/1 is used next door in Mozambique, which changes to 33/1 across the
border in neighboring South Africa.
Estimates are often combined with predictions, a mix that can produce
particularly spectacular results. One recent example is a Reuters news release
that announced “China has an estimated 400,000 people with HIV although
confirmed cases [since the beginning of the epidemic] are only about 11,000.”
In this same report, “unidentified experts” went on to predict that these 11,000
cases could grow to “one million by the end of next year.”182