20 May 2008

Aids strategies not working?

When Aids erupted more than two decades ago, health experts devised a strategy: Distribute free condoms and test for HIV, but there is little evidence current strategies work.

When Aids erupted more than two decades ago, health experts quickly devised a strategy for stopping the disease's spread in the developing world: Distribute free condoms and test for HIV.

Millions of dollars were poured into the campaign led by UN health agencies and backed by governments around the world. But what seemed like a natural way to fight the disease had little impact in Africa, the region hardest hit by the epidemic.

Now, many experts are calling for an entirely new approach to fighting Aids in Africa - saying there is little evidence current strategies work.

"Intuitively, things like condom promotion and HIV testing should work anywhere," said Daniel Halperin, an Aids expert at Harvard University's School of Public Health. "But if that were true, countries like Botswana (with Africa's highest prevalence of Aids after Swaziland) should have wiped out their HIV epidemic by now. These approachesé just haven't worked as well as we thought they would."

Condoms making no difference
In a recent article published in the journal Science, Halperin and other Aids experts argued that health officials are largely wasting money focusing on condoms, HIV testing and other strategies such as vaccine research as the main tools for preventing Aids in Africa.

Condom use in Africa hasn't reached a high enough level to make a dent on Aids transmission, and there is scant evidence to show that people change their sexual behaviour even when they know their HIV status, according to studies.

In sub-Saharan Africa nearly 21 million people were infected in 2001, according to the UN. Last year, that figure was estimated to be 22.5 million.

And despite years of research into finding an Aids vaccine, the most promising candidates have failed. Halperin and his co-authors said health officials should radically boost funding for male circumcision, which can reduce HIV transmission by up to 60 percent, and for programs to educate people to reduce their number of sexual partners.

"Almost 99 percent of the Aids prevention money is going to things that don't seem to work very well in Africa and almost none of it is going to things that would have a major impact," Halperin said.

UN argues programmes are working
UN health officials rejected the need for change and said there is some evidence in Asia that condom distribution programs reduce HIV transmission. They also said they have been working on guidelines to introduce mass male circumcision, but that such a strategy will take years to implement.

"It's not right to say that our approaches have not worked," said Paul de Lay, an Aids expert at UNAIDS. "We are seeing an impact in the epidemic's decline worldwide linked to our interventions."

Last year, the UN revised its global figures for the number of people with HIV or Aids from nearly 40 million to 33 million. But that drop was mostly due to new ways of estimating the numbers of people with HIV.

Some experts suggest the decline is due more to a natural levelling off of the epidemic, with infected people dying, rather than to the success of the UN's anti-Aids strategies.

Methods need to be changed
Earlier this year, the United States, the biggest funder of Aids efforts in Africa, agreed to triple its spending on combating Aids on the continent, pledging $10 billion annually over the next five years. The UN estimates it will need more than $3 billion by 2010 for HIV prevention efforts in Africa and $15 billion worldwide.

But some experts argue that more than two decades into the fight against Aids, the epidemic would have tapered off more by now in the developing world if current methods were effective.

"At the beginning, people said that this was a public health emergency and that we should just get in there and do something," said David Mabey, an Aids expert at London's School of Hygiene and Tropical Medicine. "But that was short-sighted. Some things are clearly not working in some countries." – (Sapa, May 2008)

Read more:
5.6 million in SA HIV positive
HIV fight off track?


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Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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