30 November 2010

Preventing HIV in Africa

Efforts to treat everyone in Africa infected with the Aids virus are virtually futile, and public health experts should instead focus on preventing new cases.


Efforts to treat everyone in Africa infected with the Aids virus are virtually futile, and public health experts should instead focus on preventing new cases, a committee of experts reported.

Currently 22.5 million people in Africa have HIV, but this number will rise to more than 30 million by 2020 - far more than can be treated with current resources, according to the report from the US Institute of Medicine.

At least 12 million of them will need treatment, but only seven million will likely get those drugs, the committee of international Aids experts appointed by the Institute said.

The findings

"The number of people that are infected with HIV/Aids in sub-Saharan Africa is projected to far outstrip the available resources for treatment by 2020," said Dr Thomas Quinn of Johns Hopkins University in Baltimore and the National Institutes of Health.

"Because treatment will only reach a fraction of those who need it, preventing new infections should be the central tenet of any long term response to HIV/Aids in Africa," added Quinn, who co-chaired the committee.

The committee's report projects that 70 million Africans will be infected with the virus by 2050 unless something changes.

"Already in Uganda and a few other nations, we don't have enough health care workers or (HIV drugs) to meet demands, and health centres are increasingly turning away patients who need these drugs to survive," said David Serwadda of Makerere University in Kampala, Uganda.

Exponential increase in deaths

"If we don't act to prevent new infections, we will witness an exponential increase in deaths and orphaned children in sub-Saharan Africa in just a couple of decades," added Serwadda, co-chair of the committee.

Aids is caused by the human immunodeficiency virus, or HIV, which is transmitted sexually, in blood and on shared needles, and from mother to newborn. There is no cure and experimental vaccines are still in the early stages of development.

A cocktail of Aids drugs can keep patients healthy but they must be taken for life and only a fraction of patients who need them get them.

Huge burden

"There are still at least 18 million people who are going to need treatment if they don't already need it. Even if incidence was zero, we would still have a huge burden of care to provide over the coming decades," said Patrick Kelley, director of the Institute's Board on Global Health.

The US government, other governments and non-profit groups have spent billions to get drugs to patients in Africa and elsewhere and have negotiated deals to get companies to agree to license and make cheap generic versions of the drugs.

But it is not enough and spending is unlikely to grow much, the committee said. African nations need to share responsibility more, the report suggests.

"In the US, the effects of an historic global financial crisis and a domestic deficit approaching $2 trillion will likely drive greater congressional scrutiny of spending on foreign assistance," the report notes.

Good options for prevention

Serwadda noted there are some good options for prevention besides using condoms and encouraging safer sex.

Recently researchers reported that taking a once-a-day pill combining two Gilead Sciences Inc Aids drugs reduced the HIV infection rate by nearly 44% in high-risk gay and bisexual men.

Previously researchers reported that HIV-infected people who took drug cocktails were 92 % less likely to infect their partners with the virus. Circumcision has been shown to protect men, as well.

A study in July showed a gel called a microbicide could help protect women against the virus and one last year showed a vaccine had a partially protective effect. (Reuters Health/ November 2010)

Read more:
HIV prevention drugs raise more questions than answers
Decriminalisation of sex work 'will help stop HIV'
Condoms still key to preventing HIV


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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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