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Rethinking AIDS Strategy After a String of Failures
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Yet when one of her regular customers -- a truck driver who paid about $35 per visit, four times the going rate -- insisted on not using condoms, she chose to risk contracting a lethal disease.
"I heard about it, but I didn't think it would happen," she said. "Your heart just tells you, you won't get it."
The unpredictable nature of human behavior helps explain the enduring allure of a vaccine. If one could be found, a single needle stick -- or maybe two or three -- would confer a degree of lifetime protection.
"Without a biomedical instrument to prevent HIV, basically the world will never be able to control HIV because people will never stop having sex," said Glenda Gray, the lead South African researcher on the Merck vaccine trial.
New Push in Old Direction
As efforts to find a vaccine or other new technological tool against AIDS have faltered, the science behind several existing but lower-tech approaches has grown stronger.
Three studies in three African countries have found that circumcising men lowers their chance of contracting HIV by about 60 percent. And like a vaccine, circumcision offers lifelong protection.
Research shows that public campaigns encouraging monogamy also helped reduce the pace of new infections in Uganda, Kenya and perhaps Zimbabwe. In each nation, falling rates of multiple sexual relationships led to declines in HIV infection rates.
Numerous studies have demonstrated that making birth control easily available to women with HIV gives them the power to keep from having babies who might contract the virus. Providing antiretroviral drugs to pregnant women also limits transmission to babies, but the medicine now reaches only one in 10 African women who need it.
These approaches do not attract the money or attention enjoyed by potential technological fixes such as vaccines or microbicides.
A recent U.N. report calling for massive new spending on AIDS projected only about 1 percent of the money funding either circumcision or efforts to change sexual behavior. There was no line item for expanding access to contraception.
Potts, the Berkeley professor, said the time has come to shift priorities toward existing strategies, however imperfect.
"If we're defeated in one area, we pull our troops back and attack somewhere else. That's what we're failing to do," he said. "We need a military response, and we have a bureaucratic response."
