AIDS and the media
JOEL
SCHWARTZ
& DAVID
A
MURRAY
TWOFOLD
lesson
about
science and the media emerges from a reading of the scientific and popular
literature
about AIDS: It's not just that the
media can, at times, misinform us about what science says; it's
also that science often speaks in an extremely
qualified
and
hesitant manner. Not only is the AIDS epidemic extraordinarily difficult to measure, but the measurements
have often been
reported
in misleading
ways. Thus the media have not conveyed the whole truth about AIDS. But it may not be possible
to arrive at that whole truth.
Why is the epidemic
estimates
of the number
so hard
of HIV
to measure?
Even the best
infections,
AIDS cases, and
AIDS deaths are highly conjectural.
This uncertainty
is not
surprising:
AIDS has been stigmatized,
largely because
it is
closely linked to behaviors
(homosexuality
and drug abuse)
that are themselves
stigmatized.
Because of the stigma (and
because AIDS still appears to be a universally
fatal disease),
people often don't want others to know that they are HIV
57
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positive or have been diagnosed with AIDS. Similarly, survivors often don't want others to know that their loved ones
died of AIDS.
As a result,
even the most
are unable to produce definitive numbers
us to pinpoint its spread with confidence.
careful
that
researchers
would
enable
In what ways have the news reports been misleading?
In
view of the media's track record of trumpeting
sometimes
dubious scientific breakthroughs
(such as cold fusion), we might
expect AIDS reporting to highlight any good news about the
course of the epidemic. But false optimism has rarely been a
problem with this story. Instead, for understandable
reasons,
the reports have tended to focus on the grimmest of findings.
Humanitarian
sentiments,
such as the desire to increase compassion and research money for victims, may motivate reporters and researchers
alike to emphasize
the horrors of this
truly horrifying ailment. But however laudable their motives,
they have ignored or downplayed
ments of genuine importance.
some
encouraging
develop-
Some promising medical advances in the fight against AIDS
have received
extensive
media coverage of late. Much less
attention,
however, has been given to other significant findings that point to the curtailment
of the epidemic: AIDS is
not claiming nearly so many American victims as scientists
expected
a decade ago; the epidemic now appears to be receding in this country, because fewer people are now being
infected
with HIV than are dying of AIDS; and the widely
feared "breakout"
of AIDS into America's heterosexual
population is now almost certain not to occur.
Declining
prevalence
estimates
The encouraging
news about the decline in the epidemic
is
evident
from the changing estimates
about the prevalence
of
HIV infections.
In 1986, the Public
Health
Service
(PHS)
estimated
that between
1.0 and 1.5 million Americans
were
infected with HIV. In 1989, those figures were revised downward to a range of 800,000 to 1.2 million. The most recent
estimate
was published
this July in the Journal of the American Medical Association
by John M. Karon of the Centers for
Disease Control and Prevention
(CDC), an arm of the PHS.
Karon concluded
that the number
of HIV infections
in 1992
AIDS
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MEDIA
59
fell between
a range of 650,000 and 900,000.
He also indicated that this estimate is still largely applicable
today.
In other words, the high end of the range of the current
estimate
is lower than the low end of the range of the 1986
estimate.
As scientists
have learned more about the epidemic,
then, they have concluded
that it will be less catastrophic
than had originally been feared.
Some of this reduction
results from the deaths of Americans who were living with HIV infection in 1986. According to
CDC figures, through the end of 1995, over 300,000 American
deaths were attributable
to AIDS. Nevertheless,
the decline in
the estimate of Americans
infected with HIV is still welcome,
because it indicates that those who have died of AIDS are not
being replaced
by an increased
number
of others living with
HIV (who might subsequently
die of AIDS).
In short, the
crucial issue is the ratio between
deaths from AIDS and new
HIV infections.
If there are fewer new infections
than deaths
(as now appears to be the case), the epidemic
is receding;
if
there were fewer deaths than new infections,
the epidemic
would still be increasing.
How have researchers
arrived
at these estimates
of HIV
prevalence?
The earliest figures, from 1986, were (in the CDC's
phrase) "a crude estimate" of the number of people in various
risk groups (such as injecting drug users and men who have
sex with men), and of the proportion
of people in each of the
risk groups who had been infected.
By 1989, the CDC could
employ "back-calculation"
to refine its earlier estimate.
Using
this approach,
researchers
project backward from the number
of AIDS cases reported annually in recent years to the number
of HIV infections
that must have occurred in previous years to
develop
into these subsequent
cases of full-blown
AIDS. In
addition,
by 1989 researchers
could incorporate
initial results
from seroprevalence
surveys, which provide
data from blood
tests about the prevalence
of HIV infections.
Finally, Karon's
data are derived
from back-calculation,
from
a national
seroprevalence
survey of childbearing women, and from a household survey of current health status. His figures are more likely
to be reliable
because
they reflect
greater
experience
with
back-calculation,
more knowledge
about the lag time between
HIV infection and the onset of AIDS, and improved
informa-
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tion about the completeness
of AIDS reporting.
The most important
information
about the epidemic--the
number of new HIV infections,
which tracks the future course
of the epidemic--is
still highly conjectural.
The broad range
in the current
estimate testifies to this continued
uncertainty.
Back-calculation
in particular
entails
numerous
assumptions
about the incubation
time of the virus, which can vary dramatically,
and about underreporting
of AIDS. Nevertheless,
it
is significant
that the estimates
have been revised downward
as scientists
have come to know
number of HIV infections.
Thus the improved
techniques
like Karon have yielded data that
more
about
measuring
the
used today by researchers
are better in both senses of
the word--more
accurate and also less worrisome.
It is clearly
encouraging
that the best current
estimate
suggests that the
epidemic
has not expanded
since 1992. In general,
Karon's
estimate offers some reassurance
about the epidemic's
future,
in comparison
with the earlier,
higher estimates.
This would
seem to be the sort of news that both journalists
and their
audience would be eager to learn.
The media
spin
By and large, however, the media put a pessimistic
spin on
Karon's findings. The July 4 Los Angeles Times observed
that
"the basic numbers
behind
the epidemic
have only gotten
bleaker
in the [last] two years." Its story included
Karon's
650,000 to 900,000 range, but did not mention
the earlier,
higher ranges that it has replaced. The July 8 New York Times
faithfully
reported
Karon's view that "the number
of infected
Americans
no longer appears
to be increasing
rapidly,
and
may even be declining
in some groups."
But the Times also
failed to mention
that the previous estimates
of HIV prevalence were higher than the new ones.
The July 7 Chicago Tribune did compare Karon's 1992 numbers to earlier figures. Ironically,
though, the comparison
was
to Karon's own estimates
of HIV prevalence
for 1984 (400,000
to 450,000) and 1986 (550,000 to 650,000), rather than to the
earlier PHS estimates--despite
the fact that the earlier estimates were discussed
in the very first paragraph
of Karon's
article. As a result, the story made the point that the epi-
AIDS AND THE MEDIA
61
demic has expanded over time, without letting readers know
that it is considerably
smaller than it was previously
thought
to be.
Some newspapers
(notably USA Today and the Washington
Post "Health"
section)
summarized
Karon's findings correctly
and placed
them in an appropriate
context.
Unfortunately,
they were in the minority.
Still more, the predominant
treatment of Karon's findings conforms to the media's general presentation
of news about the AIDS epidemic.
In several notable instances,
major media outlets
have de-emphasized
or
ignored
comparatively
reassuring
news about the epidemic's
development.
A familiar song from World War II urged Americans to "accentuate
the positive,
eliminate
the negative";
as
we shall see, our most influential
news organs have often
done just the
opposite.
Eliminating
the
positive
Consider
first two important
AIDS developments
that received
little attention
in the media. On January
30, 1996,
Robert
Biggar of the National
Cancer
Institute
presented
a
paper at the Third Conference
on Retroviruses
and Opportunistic Infections
in Washington,
D.C., in which he argued that
the numbers of HIV-infected
Americans are dropping
in nearly
all demographic
categories.
While acknowledging
the "tremendous cost" evident in the rising total of new infections
among
young people, particularly
minorities
and homosexuals,
Biggar
estimated
that substantially
fewer Americans
are now contracting HIV per year (40,000) than are dying of AIDS (60,000).
He contended
that the incidence
of new infections
has been
falling since the early 1980s: 100,000 to 150,000 previously
uninfected
Americans
were infected
with HIV in 1982, compared
with
only
40,000
in 1993.
He
further
observed
that
deaths from AIDS have outstripped
new HIV infections
ever
since 1993. Finally, Biggar calculated
that the risk of infection
for drug users declined
by 30 percent
from the 1981 to 1986
period to the 1987 to 1992 period;
the risk for white male homosexuals
during the same interval,
fell by 70 percent.
Biggar's findings would seem to be of major importance.
In
the words of Anthony
Fauci of the National Institute
of Allergy and Infectious
Diseases,
"When the number
of people
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getting sick and dying is greater than the number getting
infected, you know the epidemic
is on the wane." Furthermore, both Biggar and Fauci are AIDS researchers
of indisputable stature and long standing, who could not be dismissed
as marginal figures or crackpots.
Nevertheless,
Biggar's paper received only spotty media coverage. Articles appeared in the Washington
Times (February
1, 1996) and New York Newsday
(February
6, 1996) but not
in prestige
press outlets such as the Washington
Post or the
New York Times. What would on the face of it appear to be a
major news story about a topic of great interest
was ignored
by our most influential
newspapers.
Perhaps
they ignored
it
because it was thought indecorous
to appear to foster complacency regarding
a disease expected
to kill all its victims.
A similar pattern emerged in April of 1996, when the CDC
reported
that the number
of AIDS diagnoses
fell 7 percent
between
1994 and 1995, and the number
of pediatric
cases
fell 23 percent.
Again, this is encouraging
news coming this
time from an authoritative
governmental
agency. Again, however, the story was effectively
ignored by the Washington
Post
and the New York Times. To be more precise,
both papers
chose to treat the story as local (and discouraging)
news, rather
than national
(and somewhat
encouraging)
news. The Post ignored the story in its news columns but published
an editorial
about it on April 25. The editorial
focused on the fact that
the District
of Columbia
has a higher proportion
of AIDS
cases than any state but also argued
that the CDC figures
don't "necessarily
mean the disease is on the wane," because
"the definition
of AIDS was changed
in 1994," when "many
more cases were moved from HIV-positive
status to full-blown
AIDS." The Post continued:
"The number
of 'new' cases reported that year included
thousands
that wouldn't
have been
counted
at that stage under the old guidelines."
Therefore
the
editorial concluded
that the perceived "drop" in the 1995 numbers was "exaggerated."
Thus the Post attempted
to explain on its editorial
page
why it failed to cover this particular
bit of basically encouraging AIDS news. But the explanation
happens
to be wrong:
The CDC's redefinition
of AIDS took place in 1993 (when the
number
of AIDS diagnoses
surged to 105,828)
rather than
AIDS AND THE MEDIA
63
1994. This means that the 74,180 AIDS diagnoses
in 1995 are
in every respect
comparable
to (and represent
a genuine
decline from) the 79,897 AIDS diagnoses
in 1994.
At the Times, the report was covered by the metropolitan
desk. The subsequent
84-word story reported
that Jersey City
had attained
the "grim distinction"
of being "second only to
Washington
in numbers
of AIDS eases per 100,000 population." The Times article did note that "Jersey City's rate in
1995 was 138.1 eases [per 100,000 people],
down from 148.7
in 1994." Thus the Jersey City rate declined
by 7.1 percent,
which almost exactly replicates
the decline
in the national
rate. But the fact that this was a national trend did not make
it into America's
newspaper
Accentuating
that
For purposes of contrast,
received
more attention
of record.
the
negative
let us examine some AIDS stories
from the media. We begin with
an op-ed piece by Secretary
of Health and Human
Services
Donna Shalala, which appeared
in the March 12, 1995, issue
of the Washington
Times.
Shalala was writing
to disprove
the claim of "those who
have looked at the recent statistics
on AIDS and concluded
that this epidemic
is slowing down." She attempted
to make
this case, even though her own column effectively
provided
the data to which AIDS optimists would point: She noted that
"more than 40,000 Americans
died of AIDS" in 1994, and that
"the number of new [HIV] infections"
is "as many as 40,000 a
year"--thus
anticipating
Biggar's claim that the epidemic
is
indeed "slowing down," because
fewer people are being infected by HIV than are dying from AIDS. By definition,
an
epidemic
can expand only if more people contract
the infection than die from the disease.
It is interesting
to note the large discrepancy
between
Shalala's
and Biggar's statistics
regarding
AIDS deaths.
Remarkably,
the "optimistic"
Biggar can seem to be purveying
worse news than the "pessimistic"
Shalala, since he assumed
60,000 AIDS fatalities a year, compared
with her 40,000. This
apparent 50 percent discrepancy again illustrates that our knowledge about the prevalence
of AIDS is often conjectural
at
best; the number
of deaths
from AIDS simply cannot
be
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counted
with great precision.
Technically
speaking,
no one
dies of AIDS; people
die of other illnesses
after AIDS has
suppressed
their immune systems. Because coroners have some
leeway in ascribing
a death to AIDS, the number
of AIDSrelated
deaths reported
on death certificates
to the CDC is
not wholly reliable.
Owing to the stigma attached
to AIDS
(and as a gesture to surviving family members),
it is not listed
as a cause for many deaths that actually are AIDS related.
In fact, this February
the CDC effectively
reported
three
different
sorts of statistics for 1994 AIDS deaths. In that year,
HIV was listed as an underlying
cause on approximately
42,000
death certificates.
But HIV was listed as a nonunderlying
cause
of death for an additional
6,000 individuals.
Finally, incorporating data from other sources (to compensate
for the occasional unreliability
of death certificates),
the CDC estimated
that "55,000 to 60,000 persons
if the CDC is correct,
HIV
cause for about 30 percent
of
altogether
unmentioned
on the
between
15 percent
with AIDS died in 1994." Thus,
is not listed as the underlying
all AIDS deaths; and HIV goes
death certificates
of somewhere
and 25 percent
of all those
who die from
AIDS. The dispute between
Biggar and Shalala, then, appears
to be over which set of death statistics to use: Shalala's "more
than 40,000,"
which is the number
of death certificates
on
which HIV is listed as the underlying
cause; or Biggar's 60,000,
which is presumably
taken from the high-end
estimate
of actual deaths from AIDS (including
AIDS deaths not described
as such on death certificates).
ing,
In any event, Shalala argued that the epidemic
even though she acknowledged
fewer deaths
is worsenthan infec-
tions. Her principal case for its worsening
was that "the number of AIDS-related
deaths is growing at an annual rate of 24
percent."
But since Shalala did not explain the range of years
to which her calculation
applies, it is hard to be certain where
this figure comes from or what it means. Since AIDS is a
universally
fatal disease that was not recognized
until the early
1980s, it is obvious that fatalities
were going to rise steeply
once they began to be counted. Indeed, at one point, fatalities
almost tripled
in a single year (going from 6,689 in 1985 to
19,979 in 1986). Currently,
however,
the rise in AIDS fatalities
is far
more
modest.
According
to the
most
recent
CDC
AIDS AND THE MEDIA
65
figures, there were 41,930 deaths from AIDS in 1994, compared with 38,500 in 1993--an
increase of 9 (not 24) percent.
The more important
point is that, in a crucial
respect,
deaths are the wrong thing to measure,
because
they tell us
about the epidemic's
past rather than its future.
There are
ordinarily
long lead times between being infected with HIV,
developing
AIDS, and eventually
dying from it. As a result,
1995 AIDS death statistics
represent
a culmination
of tragedies that may have occurred
10 or 15 years ago, when the
virus first took hold. They tell us nothing
about how many
infections
or deaths there will be in the year 2000 or 2005.
For the same reason, when the CDC reports,
in an AIDS
fact sheet, that "the number
of people diagnosed
with lifethreatening
illnesses as a result of HIV infection"
is now increasing by 3 percent to 5 percent per year, it is not claiming
that this statistic indicates
an expanding
epidemic.
AIDS-related diagnoses, like AIDS deaths, tell us where the epidemic
is and where it has been. The epidemic would still be expanding only if more people were entering
the system (being infected with HIV) than leaving it (dying from AIDS).
In other words, the current
news about AIDS diagnoses
and deaths is predictably
bad, whereas the news about projections of the epidemic's
future
is, perhaps
surprisingly,
less
bad. Yet it is principally
the bad news about deaths that has
been highlighted.
For example, the New York Times published
a story on February
16, 1996, summarizing
a CDC report,
headlined "AIDS Deaths Continue to Rise in 25-44 Age Group."
This story is obviously newsworthy,
and the Times cannot
be accused
of sensationalizing
it; it appeared
on page A22.
Furthermore,
the Times story properly
pointed to the limited
relevance
of AIDS death statistics,
featuring
a quote from
John Ward of the CDC: "Death rates for AIDS [are] only one
way to measure the epidemic,"
he observed,
adding that "the
measure
that gives the most up-to-date
measure
of the continuing spread of HIV is the number of new infections."
Nevertheless,
the Times failed to place the CDC's finding
in the appropriate
context.
The Times simply reported
that
"AIDS has become the third leading
cause of death among
American
women 25 to 44 years old, and the leading cause
among white men in that age group." But these statistics can't
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be understood
unless two things are kept in mind. First, Americans (particularly
women) aged 25 to 44 tend to be healthy, so
not that many of them die.
Second, and more significantly,
AIDS is caused by behavioral patterns
that are far more characteristic
of younger than
older Americans.
People are most likely to contract AIDS when
they inject themselves
with drugs (sharing needles with someone who has the disease) or when they engage in unprotected
receptive
anal intercourse
with males who have the disease.
Such atypical behaviors
that lead to HIV infections
and AIDS
are far more likely to be encountered
among young Americans
than older ones. It is these avoidable behaviors,
not the youth
of those who engage in them, that culminate
in the deaths of
people aged 25 to 44.
That point was made convincingly
in one of the few newspaper articles to report accurately
on AIDS: a May 1, frontpage Wall Street Journal story. The article contended
that the
CDC and the media have collaborated
in spreading
an "everyone-gets-AIDS
disease was,
intravenous
children."
message" that is misleading:
"In the U.S., the
and remains,
largely the scourge
of gay men,
drug users, their
Because
it focused
sex partners
and their newborn
on the unusual behaviors
that
increase
the likelihood
of infection,
the Journal
article supported the contention
previously
made by journalist
Michael
Fumento
in The Myth of Heterosexual
AIDS and the academic
authors of Sex in America: A Definitive
Survey: The epidemic
is very unlikely to make
heterosexual
population.
serious
False
inroads
in America's
wider
universalism
Both the CDC report
and the Times story exemplify
the
tendency
to universalize
by emphasizing
the risk to an entire
age group or sex--as
opposed to emphasizing
the particular
behaviors, characteristic
of some individuals in the larger group,
which pose the greater threat.
in a widely cited recent study
Philip S. Rosenberg
of the
lished his study, "Scope of the
States," in the November
25,
That same tendency
is evident
of the future of the epidemic.
National Cancer Institute
pubAIDS Epidemic
in the United
1995, issue of Science. His ar-
ticle
comparatively
began
by pointing
to the
good
news about
AIDS ANDTHE MEDIA
67
AIDS but then--in
a familiar pattern--attempted
to discount
it. Rosenberg
observed
that "in recent years, the incidence
of
AIDS in the United
States has slowed, with rates that are
approaching
a plateau. The trend likely reflects both reduced
infection
rates since the mid-1980s
and widespread
use of
prophylactic
therapies,
which delay the onset of AIDS." He
declared
that "the plateau in national AIDS cases would appear to be a favorable sign," but tempered
this optimism
by
stating that an increasing
proportion
of the victims of AIDS
are now young adults.
It would indeed be disturbing if proportionally
more young
people were falling victim to AIDS today than in years past.
Since young people today can know what behaviors
to avoid
(as young people in, say, 1980 did not), we would expect their
rate of infection to be lower than it was in the past. However,
Rosenberg's
study did not address this crucial issue. He noted
that "a key question
is whether
the incidence
rate among
young adults has declined
in comparison
to the rate among
persons of the same age in the past," but he did not answer
that question.
Instead, he concluded
his paper with the "central observation
... that AIDS incidence
increased
much more
rapidly
in recent
years
among
younger
individuals
born
in
1960 or later than among older individuals."
Thus Rosenberg's
study did not compare young people today to young people 15 years ago. Therefore,
it did not claim
that young people are more likely to be infected today than in
the past. Instead,
it compared
young people today to older
people today. The conclusion
that the young today are more
likely to be victimized
by AIDS, while hardly welcome,
is
also, as we have described,
hardly surprising.
Further,
Rosenberg
included
only a nine-word
discussion
of behaviors
responsible
for AIDS. The rest of the article
grouped
people by age, race, ethnicity,
and sex in discussing
their likelihood of contracting
AIDS--abstracting
from the behavioral patterns
that are really at issue. But in a 1993 article,
in its publication
Morbidity
and Mortality Weekly Report, the
CDC declared
that behavior is the key variable: "Because race
and ethnicity
are not risk factors for HIV infection,
an assessment of risk behaviors
is necessary
to properly
target prevention efforts."
68
THE
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Another
encouraged
increasing
among
women
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1996
and heterosexuals
focal point of much media coverage of AIDS (again
by some research
released
by the CDC) is the
susceptibility
of women and heterosexuals
to the
disease.
Once again, the effect is to universalize,
to suggest
that everyone--not
just male homosexuals
and needle-sharing
drug addicts--is
at risk. A case in point is an article in the
April 19 issue of the Chicago Tribune which covered the release of CDC data. The article
reported
that "women
accounted
for 19 percent
of all AIDS cases among adults and
adolescents
[in 1995], their highest proportion
yet."
That is true but also misleading.
Percentages
(as opposed
to raw data) can often be misleading.
By definition,
the total
of all people diagnosed
for AIDS in 1995 has to equal 100
percent.
Because the number of infections
among male homosexuals has declined,
the percentage
of women among those
infected
has risen. This does not, however,
mean that the
actual number
of infected
women increased.
We saw above
that there were fewer diagnoses
of AIDS in 1995 (74,180)
than in 1994 (79,897). As it happens,
there were also fewer
diagnoses
of AIDS among women in 1995 (13,764) than in
1994 (13,887). But since AIDS diagnoses
among men fell still
more sharply than they did among women, the small decrease
in the actual number
of women's
new cases in 1995 (123
fewer than
centage of
reason, the
gests that
1995
them
in 1994) registered
as a small increase
in the perall cases (from 18 percent
to 19 percent).
For this
focus on the percentage
of all cases wrongly sugthe 1995 news was bad for women. In fact, the
news, while good for women,
than it was for men.
An emphasis
in the
was simply
on the risk to heterosexuals
Washington
Post's
summary
tween 1986 and 1992 the number
heterosexual
contact more than
of Karon's
less
good
for
was also evident
findings:
"Be-
of Americans infected through
tripled, growing to about 15
percent
of the total, or about 100,000 infected persons."
increase
is real but deeply misleading,
for only a specific
group of women
and heterosexuals
is at serious risk.
That
subThat
population
was identified
with unusual candor in a May 1996
article in the American Journal of Public Health by CDC researcher
Scott D. Holmberg.
Holmberg
arrived at an estimate
AIDS AND THE
MEDIA
69
of 1995 HIV prevalence
toward the low end of Karon's range
(700,000 individuals),
using a different methodology:
Holmberg
estimated
the at-risk populations
in America's
96 largest metropolitan
statistical
areas and then estimated
the proportions
of the groups likely to be HIV positive.
To arrive at the
estimates,
he studied
three different
populations:
"Injection
drug users, men who have
from heterosexual
activity."
Who makes
sex with
men,
and
persons
at risk
up this last group?
Most (70% to 80%) persons infected through heterosexual contact
are women. Also, most (80%) HIV-infected heterosexual men and
women who do not use injection drugs have been infected through
sexual contact with HIV-infected injection drug users and (for
women) much less frequently with HIV-infected bisexual men;
thus ... the geographical distribution of heterosexual AIDS cases
has been essentially the same as the distribution of male injection
drug-using AIDS cases.
Holmberg
also offered "a consistent
profile of the highly
at-risk [heterosexual]
person." She is "a generally
young, minority, indigent woman who uses crack cocaine; has multiple
sex partners;
trades sex for crack, other drugs, or money; and
has positive serologic tests for genital ulcerative
disease." That
is probably not the profile most readers have in mind when
they come across stories that report--accurately
but misleadingly--that
the percentage
of people
infected
with AIDS
through heterosexual
contact is rising sharply.
Why does such unwarranted
alarmism conveyed by so many
media accounts
matter?
Some of the reasons may be obvious
but bear repeating:
it is the media's job to convey the truth as
accurately
as possible,
and groundless
worries should not be
added to genuine
ones concerning
a disease that is already
horrifying
enough.
But there is
reason for understanding
the true
and the specific populations
on
That reason was explained
in the
tended that
also an important
practical
dimensions
of the epidemic
which it principally
preys.
Journal article, which con-
tens of thousands of infections a year could be averted if only
practical assistance were directed to the right people. Instead of
aiming general warnings at non-drug-using heterosexuals .... critics
say, the government should use the bulk of its anti-AIDS money
70
THE
PUBLIC
INTEREST
to teach homosexual men to avoid unprotected
dissuade addicts from sharing infected needles.
Limited
So the
media
have
not
/ FALL
1996
anal sex and to
knowledge
done
as well
as they
should
in
conveying to the public what we now know about AIDS. Ironically, however, they can also be faulted for not explaining how
little is known about AIDS altogether,
and how conjectural
most AIDS statistics
inevitably
are. For instance,
the most
important
AIDS statistics for tracking the epidemic's
future-the incidence
and prevalence
of HIV infections
that have not
yet developed
into full-blown
AIDS--are
largely a matter of
educated
guesswork on the part of researchers.
How uncertain
are the prevalence
estimates?
Karon's article stated that "all 3 methods [that he used] to estimate HIV
prevalence
... yield estimates
that are subject
to substantial
uncertainty."
Similarly, Holmberg
spoke of the "obvious and
unavoidable
methodological
limitations"
to his study and acknowledged
that many of his decisions "were necessarily
arbitrary." Yet, of the articles reporting
on Karon's findings, only
the Post's stressed the manifold uncertainties.
The CDC estimates
of the incidence
of new HIV infections
are no more certain. As of the end of 1995, only 26 states
required
confidential
reporting
by name of all persons
with
confirmed
HIV infection.
This is not to say that the numbers
reported by those states are
that arriving at a national
with difficulty.
By contrast,
to be reported
to the CDC.
mates that it hears of only
The obstacles
to accurate
midable when one considers
infallibly accurate. Rather, it shows
figure for all 50 states is fraught
all actual AIDS cases are required
Nonetheless,
the CDC itself esti86 percent
of these.
counting become still more forthat the very definition
of AIDS
has been hotly contested
and has changed
frequently.
The
CDC broadened
its criteria
for determining
what constitutes
AIDS first in 1985, again in 1987, and most recently in 1993.
More than half the cases reported
to the CDC in 1993 would
not have been classified as AIDS under the definition
prevailing in 1992. Such changes in definition
inevitably
complicate
the task of tracking the epidemic's
development
across time.
Finally, although
statistics
about AIDS deaths derive chiefly
AIDS AND THE MEDIA
from death certificates,
certificates
of as many
71
the CDC speculates
that the death
as one-fourth
of all AIDS victims may
omit any mention of HIV.
Ordinarily,
though, a newspaper.story
will simply report a
finding from the CDC about the number
of HIV infections,
AIDS cases, or AIDS deaths. The uncertainties
to which the
CDC and other researchers
readily admit are generally
ignored.
One can certainly
understand
why newspapers
have
tended to ignore the manifold
uncertainties
about AIDS statistics (and, it need hardly be said, about many other sorts of
statistics).
The job of newspapers
is, after all, to convey information.
Most readers are doubtless
more interested
in learning what the
tain
conclusion
is than in being
told why it is uncer-
and provisional.
Nevertheless,
the real story often lies in the difficulty
of
knowing where the truth actually lies. But this is not, generally speaking, a story that the media are interested
in telling.
For that reason, our criticism of media coverage of the AIDS
epidemic
is twofold and, perhaps,
paradoxical.
Not only have
the media often failed to convey the whole truth about the
epidemic,
they have also usually failed to convey why we can't
know the whole truth about the epidemic.