The Great Debate

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.

– Dr. Kevin Fenton is the CDC’s director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. The views expressed are his own. –

Recent months have brought startling reminders about the HIV crisis in the United States.

When health officials in Washington, DC reported that three percent of city residents are living with HIV, including nearly seven percent of the city’s black men, the media and much of the nation reacted with surprise.  Yet, the reality is that DC is not the only American city that faces a severe HIV epidemic.  Many urban areas-from major cities like San Francisco and New York to smaller communities like Columbia, South Carolina and Jackson, Mississippi, are heavily impacted by HIV and AIDS.

- 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.

-- 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.