The Great Debate UK

from The Great Debate:

Four major misconceptions about the global HIV/AIDS epidemic

The following is a guest post by Daniel Halperin, who is on the faculty of Harvard School of Public Health and is finishing a co-authored book on AIDS. The opinions expressed are his own.

During the biannual International AIDS Conference this week in Vienna, there will be a strong push to increase funding for HIV/AIDS, along with calls to focus more on prevention of it. Given the poor track record of technological advances in HIV prevention, there is eager anticipation about a possible new vaginal gel that could help protect women from getting the virus. While future possibilities, such as the gel, and rhetoric in Vienna are well-intentioned, some of the assertions about AIDS are quite flawed. Here are four key misconceptions about AIDS:

1) Providing AIDS medications to everyone is the best prevention method. A new buzz phrase in the AIDS world is the “test and treat” notion. Some mathematical models have suggested that if tens of millions of people across Africa were tested for HIV, and everyone who tested positive was immediately placed on life-long antiretroviral medications, it would eventually end the epidemic. Such assertions are financially unrealistic, and rely on extremely optimistic and flawed modeling.

Real world evidence, in places such as America and Europe, suggests that although widespread treatment probably helps to reduce the infection rate, it does not eliminate it. So, instead, we should provide life-saving drugs to the people who urgently need them, rather than diverting expensive drugs, which can often have serious side effects, to millions of otherwise healthy individuals for a mainly speculative prevention benefit.

Preliminary research about potential “antiretroviral vaginal gels” will be presented Tuesday in Vienna. Such approaches could eventually help protect some women but, like condoms, they would need to be applied each time prior to sex. The gels may also have long-term toxic side effects and carry the risk that people will stop using more effective methods, like condoms or mutual fidelity, on the assumption they are now “protected” against HIV.

2) Behavior change doesn’t work. Some long-standing prevention approaches, such as condoms, are effective at reducing risk, though the actual impact of programs vary considerably depending on the nature of the local epidemic. In countries where the driving force of AIDS is sex work, such as in Thailand or Cambodia, “100% condom” promotion programs have often been quite successful at reducing the rate of new infections.

In the much more severely affected countries in southern Africa, however, there is less indication that the heavy investment in condom programs has slowed the epidemic. That’s mainly because it is notoriously difficult to maintain consistent condom use in the more long-term – and often overlapping – sexual partnerships where most HIV transmission in Africa occurs. Thus, in such settings it is crucial to also promote having fewer sexual partners.

from The Great Debate:

Pedro’s story still relevant today

- Bill Clinton is founder of the William J. Clinton Foundation and the 42nd President of the United States. The opinions expressed are his own - Fifteen years ago, when Pedro Zamora appeared on MTV's The Real World, he changed the face of HIV/AIDS in America.

For the first time, viewers saw an openly gay, HIV-positive young person on national television. As we followed his story each week, Pedro humanized the growing epidemic, reducing our ignorance and fears and increasing our determination to act. By living bravely and allowing MTV to show his story, Pedro set an extraordinary example of what a tremendous impact a single person can make in our world.

Pedro's story and his message remain powerful and relevant. Today, more than 1 million Americans are living with HIV, and 20 percent of them don't know they are infected. Infection rates are increasing among certain groups, including women of color. The HIV infection rate in Washington, D.C. - at 3 percent - is comparable to some African countries where AIDS is the number one cause of death.

It's critical for our nation to intensify the fight against HIV/AIDS here at home, starting with testing. Lack of information, misconceptions, and social stigma keep too many people from getting tested. Others mistakenly believe they have been tested as part of routine health care visits. Rapid result tests, including basic oral swabs, make it easy for anyone, anywhere in the country to be tested for HIV. Non-invasive testing is also available for other, more prevalent STDs, including chlamydia, gonorrhea.

Today marks the start of National STD Awareness Month. Several organizations on the frontlines of the HIV/AIDS and broader STD efforts are beginning a concentrated push to get as many people tested as possible this April. This is an opportunity especially for younger people who have never lived in a world without the threat of HIV/AIDS to confront these challenges head on. I urge all Americans, particularly those under age 25 who are sexually active, to get tested for STDs and make responsible decisions about their sexual health. Our actions now will shape the future of the AIDS epidemic and our country's health.

Abroad, we're fighting a different challenge: worldwide, there are 33 million people living with HIV/AIDS. Millions now have access to treatment, thanks to The Global Fund, the U.S. PEPFAR program, the Gates Foundation, UNITAID, and many others, including my foundation's HIV/AIDS Initiative (CHAI). More than 1.4 million people are now accessing more affordable, lifesaving antiretroviral treatment under CHAI's pricing agreements. But severe challenges remain in expanding access to everyone who needs it, in stopping mother-to-child transmission, and in preventing new infections.

This requires thinking big - building health systems that bring services to rural communities and increasing the number of frontline health care workers who can educate people on prevention, test those who need it, and supplying medicines for treatment. Without these basic, high-impact health services, too many people are dying and more are being infected than we can treat.

Toll of malaria high for African women

– Ray Chambers is a philanthropist and humanitarian who has directed most of his efforts towards children. In 2008, the U.N. Secretary-General appointed him as his first Special Envoy for Malaria. The views expressed are his own. –

Malaria infects one quarter of a billion people each year. Nearly one million of those afflicted die, taxing overburdened health infrastructures and decreasing productivity in Africa, where 90 percent of cases occur.

In some countries on the continent, 60 percent of all outpatient visits are malaria related, with one quarter of worker absenteeism due to the disease. Taking all lost time and productivity into consideration, malaria costs Africa more than $30 billion annually.

The mosquito carrying the deadly malaria parasite makes no distinction when choosing its victim. Young or old, male or female, everyone in endemic regions remains at risk; however, International Women’s Day on March 8th prompts us to examine independently the immense burden women shoulder as a result of malaria.

The disease strikes infants, children under five and pregnant women in astonishing disproportion, as these segments of the population account for 90 percent of malaria deaths. Given the dual role of women as both victim and primary protector of victims, malaria clearly belongs under the umbrella of traditional women’s health issues.

It deserves particular recognition as a priority in maternal health, which the World Health Organization defines as pregnancy, childbirth and the six-week postpartum period.