how best are best practices?

You may have heard the flutter over UNAIDS’s report showing 17% reductions in HIV prevalence in sub-Saharan Africa. Sounds like good news all around, right? Well, here are brief thoughts on a few concerns i have about those figures.

  • i haven’t read the methods for the estimation closely, but it’s highly probable that some shifting population dynamics may be part of the story (e.g., recent declines in fertility – albeit modest – may be reducing the number of susceptibles sufficiently to shift the population structure enough to appear like a reduction when it’s not really one; similarly i don’t know how shifts in AIDS-specific mortality, have been accounted for either).
  • Perhaps more problematically for these estimates, given things that i have encountered personally in field work in Malawi, is the fact that those who know they are positive are more likely to refuse additional testing in the future. And with the – again, albeit limited – uptick in testing in many countries in SSA recently, the declines may be in part reflecting those refusals more than an actual drop in prevalence (see dadakim for more on this point).
  • i’d prefer to not always play the pessimist, i just think that this one should be read a bit cautiously.

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    2 Responses to how best are best practices?

    1. Michael Bishop says:

      You did field work in Malawi? Awesome.

      These are good points. One thing we could do is pay people to be tested. That should reduce refusal rates… at the very least, refusal rates should be published and we should have survey data on refusers as well as non-refusers.

    2. Bob Hanneman says:

      Not to be grim about it, but…

      Couldn’t declining prevalence also result from higher mortality among the infected?

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