HIV Prevention Programs Work -- Where They're Used

The June 20 front-page article "Spread of AIDS in Africa Is Outpacing Treatment" rightly pointed out that HIV continues to spread rapidly throughout much of Africa. But it would be a mistake to conclude that prevention programs don't work.

Many HIV prevention interventions have been proved effective through rigorous scientific trials. No single intervention is a magic bullet -- including programs to promote sexual monogamy and adult male circumcision -- but when deployed in combination, prevention efforts can have a huge impact. Countries such as Uganda, Senegal and Thailand have shown this, especially when programs are targeted at people at highest risk. And new data from South Africa show the first-ever decline in HIV prevalence among young pregnant women.

But prevention programs have not been implemented on a sufficient scale in Africa -- meaning they do not reach enough people, with enough intensity, to curb the epidemic. Only a small fraction of Africans receive basic AIDS education or have access to condoms. Just one in 10 HIV-infected pregnant women has access to drugs that can prevent HIV transmission to their babies.

In addition, far too little has been done to address underlying factors that increase HIV risk -- such as poverty, gender inequalities and a lack of reproductive health care. According to a new report by the Global HIV Prevention Working Group, dramatically expanded prevention efforts could avert half of the 60 million infections projected to occur globally by 2015.

DAVID M. SERWADDA

Kampala, Uganda

SALIM ABDOOL KARIM

Durban, South Africa

The writers are members of the Global HIV Prevention Working Group.