HIV Prevalence Rates Level Off, Decline in Cities in 11 Hardest-Hit African Countries, USAID Study Shows
HIV prevalence rates are showing "widespread" signs of leveling off or declining in cities in 11 of the hardest-hit countries in sub-Saharan Africa, according to a study of U.S. Census Bureau data conducted by the U.S. Agency for International Development, the Boston Globe reports. However, the rates in the cities are still "disturbingly high," and analysts are not sure whether the new data can be attributed to the effect of prevention programs, changes in sexual behavior or an increase in the number of people who are dying from AIDS-related diseases, according to the Globe. "It's too early to call this a victory, but if everything continues to go in the right direction, we may have something here," UNAIDS Executive Director Peter Piot said. The study found that cities in Rwanda, Ethiopia, Tanzania and Uganda are experiencing declining HIV prevalence rates, while prevalence rates in cities in Zimbabwe, Malawi, Zambia, Kenya, Cote d'Ivoire, Democratic Republic of Congo and Senegal are stabilizing. The study also found that rates are continuing to rise in cities in South Africa, Namibia, Nigeria, Mozambique and Cameroon. Stephen Lewis, U.N. special envoy for HIV/AIDS in Africa, said, "I'm inclined to think this is good news, that whatever is triggering the leveling off has to give people some hope that the intensity of our response is having some impact." Paul Zeitz, director of the Global AIDS Alliance, said that the data are possibly "exciting," especially for those areas where HIV prevalence is extremely high. "Does this mean, though that death rates are accelerating?" he asked, adding, "We don't know. It could mean that so many people are dying that people are starting to change their behavior." Lewis supported that theory, lauding "rapidly expanding" prevention efforts in urban areas.
Tailored Prevention Messages
The issue of whether prevention methods should be tailored to individual countries or areas "has risen in prominence in recent weeks" in Washington, D.C., according to the Globe. UNAIDS and USAID for years have promoted the "ABC" -- abstinence, be faithful, use condoms -- approach to HIV prevention. Within that framework, USAID has for more than 10 years directed its prevention funding toward the use and promotion of condoms, a strategy that "now is in flux and under attack," according to the Globe. USAID research shows that although the ABC prevention model is a "key factor" in lowering HIV prevalence in Uganda -- from 15% in 1991 to 5% in 2001 -- condom use did "not necessarily play a major role" in the lowered rates, the Globe reports (Donnelly, Boston Globe, 5/11). A $15 billion global AIDS bill, sponsored by Rep. Henry Hyde (R-Ill.) and passed by the House on May 1, includes an amendment proposed by Rep. Joseph Pitts (R-Pa.) that would specifically allocate one-third of the bill's HIV/AIDS prevention funding for abstinence programs. The bill, which endorses the ABC model, would authorize $3 billion a year for five years to international HIV/AIDS programs, with up to $1 billion in fiscal year 2004 going to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Kaiser Daily HIV/AIDS Report, 5/2). In addition, Secretary of State Colin Powell in a cable sent in December 2002 to all USAID missions asked them to review any existing HIV/AIDS prevention contracts held with nongovernmental organizations to ensure that they "reflect appropriately the policies of the Bush administration." In one section, Powell said that the ABC approach should be employed but then "pointedly deemphasized condoms," according to the Globe. "Empirical evidence shows that successful programs support a strong emphasis on campaigns that promote abstinence, faithfulness and reduction of the number of partners," the cable said. According to the Globe, USAID officials refused to comment on the study or the cable. Piot said that having a primary focus on abstinence will not work, adding that "condoms will have to play a role," especially in areas where HIV prevalence is as high as 70%, such as in Chiredzi, Zimbabwe. "Over the years, people have told me that male circumcision was the answer. People told me that condoms would stop AIDS. Now it's abstinence," Piot said, adding, "One country cannot pose a policy of abstinence on the rest of the world. Let's stick to the science. Let's stick to what works in each particular place" (Boston Globe, 5/11).