AIDS lesson from Orange Farm, but prevention is being neglected
In a world-first, a trial on 3274 Orange Farm men aged 18 to 24 years found that circumcision reduced men’s risk of contracting HIV during sexual intercourse by over 60%.
This trial is now being followed up by two efficacy trials of over 7 000 adult men in Kenya and Uganda, with results expected in 2007.
Should these trials, which will follow men over a longer period, support the South African findings, UNAIDS is likely to add circumcision to its preventive armoury against HIV.
UNAIDS is concerned that many countries are emphasizing AIDS treatment an neglecting prevention.
Thailand which has slashed its prevention budget by two-thirds as an example.
While in Uganda, antiretroviral coverage has increased almost 10 times from 6.3% in 2003 to 56.0% in 2005, yet prevention of mother-to-child transmission has only risen from 4.6% to 12%.
But, warns UNAIDS, a global treatment-based programme would only avert about nine million new infections by 2020, whereas a programme that combines both prevention and treatment could avert 29 million new HIV infections.
‘If anything has been learnt from the past 25 years of the epidemic, it is that HIV prevention works,’ says the report.
‘The early successes of Brazil, Thailand and Uganda in reversing their national AIDS epidemics through courageous political leadership and starting strong prevention efforts early have been well documented.’
Prevention efforts are also starting to reduce HIV in Cambodia, Zimbabwe, parts of Burkina Faso, Haiti, Kenya and the United Republic of Tanzania.
‘But most people at high risk of HIV infection have yet to be reached by HIV prevention, as many policy-makers refrain from implementing approaches that have been shown to work,’ note the report.
These include young people, sex workers and men who have sex with men.
‘The steady growth of the AIDS epidemic stems not from the deficiencies of available prevention strategies but rather from the world’s failure to use the highly effective tools at its disposal to slow the spread of HIV,’ the report notes.
Prevention aimed at young people under 25, who account for over half of all new HIV infections, are particularly urgent.
These programmes should encourage young people to abstain from sex or have sex when they are older, remain faithful to their partners and use condoms.
‘Countries that have lowered HIV incidence have benefited from the emergence of new sexual behaviour patterns ‘ fewer commercial sex transactions in Cambodia and Thailand, delayed sexual debut in Zimbabwe, increasing emphasis on monogamy in Uganda, and an increase in condom use,’ notes the report.
For sexually active people, the condom remains the most effective preventive measure. If used properly and consistently, condoms reduce the risk of sexual transmission of HIV by between 80 and 90%, which is more efficient than many of the world’s standard vaccines.
Less than 8% of pregnant women in the world are currently offered services to prevent
mother-to-child transmission of HIV, yet efficient PMTC programmes in the developed world have virtually eradicated mothers passing HIV to their babies.
HIV tests are also an effective prevention tool, as most people diagnosed with HIV ‘take steps to avoid exposing others to the virus’.
But most people living with HIV are unaware of their status as they cannot get an HIV test.
Programmes to empower girls and women so that they are able to refuse unsafe sex are also essential for prevention.
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