Experts Plan Strategies to Prevent HIV

The Associated Press
Thursday, November 30, 2006; 7:32 PM

LONDON -- Circumcision, microbicides and microfinance. These are some of the most promising options being examined as potential ways to prevent AIDS. As World AIDS Day is marked Friday, some public health experts are saying the current focus on universal access to lifesaving antiretroviral drugs has had an unintended effect: sidelining prevention. Without a vaccine, preventing HIV infections is key to controlling the pandemic.

New strategies that attempt to change the very environment of AIDS transmission are now being considered. A study published online Thursday in the British medical journal The Lancet describes how a microfinance project in South Africa cut women's chances of domestic violence by more than half.

There is a strong link between HIV transmission and abusive relationships, with abusive men more likely to have multiple partners or to become violent if asked to use condoms.

"If you address the broader risk environment, women and communities can be quite creative in finding solutions," said Dr. Julia Kim, one of the Lancet study's authors.

In the study, 430 women in rural South Africa were loaned money to start small businesses. Most women sold fruit, vegetables, clothes or offered tailoring services. With economic and social independence, women were no longer obligated to remain in violent relationships.

Rates of HIV infection continue to grow, with 4 million new cases worldwide every year. The battle continues to be waged even in countries that were previously models of control. Due to erratic condom use and the virus' spread into new populations, like married women, HIV has made a worrying return to countries such as Thailand and Uganda.

"We need to run faster to get ahead of the virus," said Jennifer Kates, vice president and director of HIV policy at the Kaiser Family Foundation, an independent U.S.-based organization that works on AIDS issues worldwide. Because the AIDS outbreak is accelerating, so too must the public health response.

Dr. Purnima Mane, a senior UNAIDS official, estimates that public health officials need to plan for at least the next two decades before seeing a substantial decline.

There is no one-size-fits-all solution. Only in sub-Saharan Africa is AIDS really hitting the general population. In the rest of the world, intravenous drug users, prostitutes and gay men are at highest risk.

"You have to focus on where transmission is actually occurring," said Dr. Kevin De Cock, director of the HIV/AIDS department at the World Health Organization. Surprisingly little information is available on how most HIV infections are acquired. Without that, it is difficult to know which interventions would be most effective.

Even when countries do know where AIDS is spreading the fastest, there is no guarantee they will focus on the epicenter. In Latin America, the disease primarily infects gay men. And in much of Russia and eastern Europe, it is drug users. Yet in both regions, most resources go toward educating general populations.

"We would make quite a bit of headway if countries acted on the information they had," Mane said.

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