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An aggressive national campaign to persuade people to abstain from sex or commit to 100% condom use for a month could make a significant contribution to HIV prevention efforts, says a leading HIV expert.
Alan Whiteside of the Health Economics and HIV/Aids Research Division (HEARD) at the University of KwaZulu-Natal is trying to get the Aids community talking about this and other innovative strategies to curtail HIV.
Addressing delegates at the Third HIV/Aids in the Workplace Research Conference in Johannesburg earlier in November, Whiteside pointed out that in countries such as Swaziland, where nearly 50% of women aged 25-29 are HIV-positive, past prevention efforts have failed catastrophically.
"We have to deal with these HIV infections in the years ahead and we know that an ounce of prevention is worth a pound of cure," he said, adding that unless there are improvements in prevention, already over-stretched budgets and health systems will be unable to keep up with the demand for HIV/Aids treatment in years to come.
No sex month
In an article published in the Southern African Journal of HIV Medicine, Whiteside and his co-author Justin Parkhurst of the London School of Hygiene and Tropical Medicine argued that a national "safe sex/no sex month" could help reduce the spread of HIV by skipping the period immediately after an individual acquires the virus when they are most infectious. Models estimate that about 10% to 45% of HIV infections result from sex with people in this "acute infection" period.
"We want to try to intervene in that period," Whiteside told the conference. "If we could stop incidence for a month or a little longer, [it] would have a huge impact on our epidemic in this region."
In their article, Whiteside and Parkhurst referred to Ramadan when Muslims abstain from sex during daylight hours for a month as evidence that people can reduce risky sexual behaviours over a set period of time.
While the messages of abstinence and consistent condom use are not a radical departure from current prevention messages, Whiteside believes the clear time-frame for the intervention makes it an easier sell. It could also be adapted to suit the needs of different populations. For example, in a country where new infections appear to be driven by sex work, a month of "no commercial sex work" or a "month of monogamy" might make sense.
'Simple and logical model'
The controversial proposal has never been tried or even modelled but Whiteside told IRIN/PlusNews that its simplicity and logic have attracted the attention of researchers and governments.
The London School is among the research institutions interested in testing the hypothesis with mathematical modelling but even before any results become available, the Swaziland government may act on the idea.
"My understanding is that this is something Swaziland is going to pick up and run with," Whiteside said, adding that the country's small, homogeneous population and its traditional and very influential leadership made it the ideal place to try a safe sex/no sex month.
"Why wait?" he asked. "It can't do any harm and we'll know in nine months [from the number of pregnancies] whether it worked or not." - (IRIN/PlusNews, November 2010)
