WHO retracts claim half of Greek HIV infections were self-inflicted, blames 'editing error'

The WHO's latest health inequity report made a startling claim that "about half" of those with HIV deliberately infected themselves in order to claim benefits, a claim not backed by the study cited.

You may have seen this tweet going around yesterday, featuring a screenshot of the most recent issue of New Scientist:

This statistic is unbelievably horrific - that is, it is so horrifying that it is hard to believe it’s true. It comes from the World Health Organisation’s final “Review of social determinants and the health divide in the WHO European Region” report, which was prepared by University College London’s Institute of Health Inequity. You can read it here.

The passage that the New Scientist piece seems to refer to is this, on page 112:

Suicides rose between 17 percent between 2007 and 2009 and to 25 percent in 2010, according to unofficial 2010 data. The Minister of Health reported a further 40 percent rise in the first half of 2011 compared to the same period in 2010. Suicide attempts have also increased, particularly among people reporting economic distress. Homicide and theft rates have doubled. HIV rates and heroin use have risen significantly, with about half of new HIV infections being self-inflicted to enable people to receive benefits of €700 per month and faster admission on to drug-substitution programmes.

In this section, “about half” is cited as coming from a 2011 study published in the Lancet. That study - available to read here - records a 52 percent increase in the number of HIV infections in 2011 compared to 2010. It also claims that “half of the currently observed increases [are] attributable to infections among intravenous drug users”, which sounds like it could be what “about half” in the WHO report was referring to.

However - as Media Matters has pointed out - the section of the WHO report that deals with self-inflicted infections actually claims this:

An authoritative report described accounts of deliberate self-infection by a few individuals to obtain access to benefits of €700 per month and faster admission onto drug substitution programmes. These programmes offer access to synthetic opioids and can have waiting lists of 3 years or more in urban areas.

That figure, in turn, is cited as coming from the Greek Documentation and Monitoring Centre for Drugs. It’s not “about half”, not even close. Considering the WHO’s authority on matters like this - which usually means reputable publications like New Scientist can take its reports at face value - it’s a serious mistake to make.

The WHO has now admitted it made a mistake:

In this report, an erroneous reference is made to: “HIV rates and heroin use have risen significantly, with about half of new HIV infections being self-inflicted to enable people to receive benefits of €700 per month and faster admission on to drug substitution programmes.”

The sentence should read: "half of the new HIV cases are self-injecting and out of them few are deliberately inflicting the virus". The statement is the consequence of an error in the editing of the document, for which WHO apologizes.

If that really was the result of "an error in the editing of the document" - which is PR speak for "typo" - then that's baffling, as what they say the sentence should have read is nothing like what it actually reads. The kindest guess is that two sentences - one about half of those being infected had been sharing needles, one about self-inflicted infections - somehow became combined in a hasty edit.

It's also extremely unfair on the residents of Greece who are - as the report makes very clear - suffering quite enough under the effects of austerity to be given such a desperate reputation on top.

The logo of the World Health Organisation. (Photo: Getty)

Ian Steadman is a staff science and technology writer at the New Statesman. He is on Twitter as @iansteadman.

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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear