Support for Treatment Should Not be Sacrificed for Fear of Hampering Prevention Efforts, Opinion Piece States
Treatment access campaigns that have won price concessions from drug makers have "converted the public perception of AIDS from an insolvable tragedy to a moral issue and an opportunity to save lives," "instilled hope in millions of individuals" and "mobilized broader society in some of the most severely affected countries," Alan Berkman, a faculty member at the HIV Center for Clinical and Behavioral Research of the New York State Psychiatric Institute and Columbia University, writes in an American Journal of Public Health opinion piece. As treatment access campaigns make gains, "demands that governments and international agencies develop a comprehensive plan to stop the global epidemic" have increased. One such plan is the Global AIDS and Health Fund proposed by U.N. Secretary-General Kofi Annan, he states. The proposed $7 billion to $10 billion fund would seek to control AIDS, malaria and tuberculosis in the developing world by improving health infrastructure, treating those already infected, strengthening prevention efforts and funding vaccine and drug research. But the plan has "proved controversial" because some fear that HIV "will be 'medicalized' and prevention efforts will be lessened," he continues.
Treatment Must Accompany Prevention
Prevention efforts alone are "inadequate in countries with established, high-prevalence epidemics," Berkman states. Programs that "only offer condoms or counsel abstinence" are "woefully inadequate and cannot penetrate the inertia and sense of hopelessness that accompanies epidemic death and dying," he adds. Treatment offers people hope, preserves and strengthens society's "human infrastructure" by keeping HIV-positive individuals who are often the "most effective and committed advocates for prevention" alive and offers people a "powerful life-or-death incentive" to be tested. Treatment will also help lower the number of children born with HIV by bringing in more pregnant women for testing, he continues, adding that women who "know that they can save themselves" along with their babies are more likely to be tested, Berkman says. Treatment may also reduce transmission of the virus, he writes, citing studies that have found that people with lower viral loads were less likely to transmit HIV to their sexual partners. "Whether the same is true for someone whose viral load is reduced by medication is unanswered, but it is scientifically plausible," he adds. Setting up a health care infrastructure for treatment will also aid in the distribution of an HIV vaccine, should one become available, Berkman states. The U.N. Global AIDS and Health Fund's plan is "unabashedly optimistic," but "not necessarily utopian," he writes. "Debates that counterpose prevention and treatment can potentially undermine the momentum that has been generated by treatment access campaigns in both high-income and low-income countries. The world has been humbled by the HIV epidemic and enriched by the lives and lessons of those who have struggled against it. We need to take the next step toward ending it," Berkman concludes (Berkman, American Journal of Public Health, September 2001).