The Great Debate UK

Using treatment to prevent HIV

–Jessica Wapner writes on biomedical issues on her PLOS (The Public Library of Science) blog, Work in Progress. The opinions expressed are her own.–

Despite widespread knowledge of how the AIDS-causing virus HIV is transmitted, and how to prevent it, the disease is still spreading. An estimated 34 million people worldwide were living with HIV/AIDS in 2010, according to the World Health Organization. Sub-Saharan Africa is the worldwide epicenter, with 22.9 million people living with HIV/AIDS, but epidemics and areas of high concentration abound elsewhere, including in Western Europe and the southern United States. Now, an emerging concept known as treatment as prevention – where patients are given medication for the primary purpose of stopping new infections – is gaining favor as a way to decrease the spread of HIV, if not end it altogether.

Antiretroviral therapy (ART) can halt the progress of HIV in infected people, and prevent them from passing it on by reducing the amount of virus in the body. It is rarely initiated at the time of diagnosis because the disease usually isn’t causing physical deterioration at that point, but the lag between diagnosis and starting ART leaves a wide window for new infections. (WHO guidelines recommend starting ART when the level of CD4 cells – an infection-fighting component of the immune system that is gradually destroyed by the virus – plummets below 350 cells per cubic millimeter, far below the normal range of 500-1,500 cells per cubic millimeter).

For years, studies have explored whether starting ART earlier could help prevent the spread of HIV. A landmark finding published last year in the New England Journal of Medicine came from the large HPTN 052 clinical trial which found that starting ART early reduced the rate of transmission between stable, heterosexual partners by 96%.

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:

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.

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.