Lancet Publishes Letters in Response to Previous Articles, Editorials on HIV/AIDS Issues
The Sept. 18 issue of the Lancet includes several letters responding to previous articles and editorials concerning HIV/AIDS issues. Summaries of some of the letters appear below.
- Alvaro Alonso, "Strategies in HIV prevention: the ABC approach": Although a July 24 Lancet editorial said that the ABC prevention method -- meaning Abstinence, Be faithful and use Condoms -- is "difficult" to implement in developing countries, there is a "growing amount of evidence suggesting that this approach for HIV prevention is effective," Alonso of the University of Navarra School of Medicine in Spain writes. Alonso continues, "Simplistic criticism of ABC strategies, based on moral or ideological grounds rather than science, should be avoided," adding that in order for the strategy to be successful, "women's empowerment is crucial" (Alonso, Lancet, 9/18).
- William Rifkin, "Strategies in HIV prevention: the ABC approach": As noted in the July 24 Lancet editorial, the United States' commitment of $15 billion to fight HIV/AIDS through the President's Emergency Plan for AIDS Relief is "more than twice the amount donated by the rest of [the] world combined," Rifkin of the Department of Medicine at Waterbury Hospital in Connecticut writes. He says that governments of countries most affected by the epidemic "often spend money on their militaries, deny the problem of HIV/AIDS or simply do too little too late." Therefore, "to criticize President Bush over his spending on AIDS is indeed churlish," Rifkin writes, concluding, "If more of the tyrants and corrupt regimes affected had been so motivated, maybe the epidemic would not have raged so fiercely" (Rifkin, Lancet, 9/18).
- Roger England, "HIV/AIDS: The private sector is vital": Increased funding for HIV/AIDS initiatives in the private sector is "urgently need[ed]" because the public sector in developing countries is "sadly" not capable of providing health services, England of the Institute for Health Sector Development writes in response to a July 3 Lancet article (England, Lancet, 9/18). In the article, Juan Pablo Gutierrez of the Division of Health Economics and Policy at Mexico's National Institute of Public Health and colleagues estimated that nearly $6 billion is needed to reach the World Health Organization's goal of providing three million people with antiretroviral drugs by 2005 as part of its 3 by 5 Initiative (Kaiser Daily HIV/AIDS Report, 7/2). Although "public sectors have a vital part to play in the expansion of HIV/AIDS services," they are "not going to succeed on their own," England says, concluding, "Better yet would be to bypass government completely with money for private initiatives, provided these are working within national plans" (England, Lancet, 9/18).
- Aranka Anema et al., "Is '3 by 5' enough? Recalculating the global need for antiretroviral treatment": Although WHO's 3 by 5 Initiative aims to treat three million people with antiretroviral drugs by 2005, Anema and colleagues -- of the British Columbia Centre for Excellence in HIV/AIDS and University of British Columbia in Vancouver, Canada -- estimate that 8.9 million HIV-positive people in the developing world should receive the drugs based on their use in North America and Western Europe. Therefore, the international community should "be aiming beyond '3 by 5'" and lobbying for an increased financial and operational commitment from WHO donor countries, the authors conclude (Anema et al., Lancet, 9/18).
- Daniel Halperin and Glenn Post, "Global HIV prevalence: The good news might be even better": Improved methods in HIV surveillance, including the Demographic and Health Surveys-Plus, suggest that HIV/AIDS prevalence estimates for many countries may be lower than previous data indicated, Halperin and Post of the Office of HIV/AIDS at USAID write in response to an article in the June 26 issue of the Lancet (Halperin/Post, Lancet, 9/18). The article reported that HIV/AIDS estimates in the annual UNAIDS report were lower than those reported in 2002 primarily because of changes in estimates for sub-Saharan Africa based on improvements in surveillance methods (Kaiser Daily HIV/AIDS Report, 6/30). Advances in surveillance methods not only "improv[e] the science and art of delivering prevalence estimates" but may also influence policy decisions and prevention methods, the authors say (Halperin/Post, Lancet, 9/18).
- David Wilson et al., "HIV-1 prevention in the context of increasing access to treatment": There is a "need to progress from traditional" prevention and treatment approaches toward a "notion of sexual and reproductive health" for people living with HIV/AIDS, Wilson, medical coordinator for Medecins Sans Frontieres Thailand, and colleagues write in response to a July 3 Lancet letter written by former International AIDS Society President Joep Lange and Helene Gayle, director of the HIV, tuberculosis and reproductive health program at the Bill & Melinda Gates Foundation, which advocated increasing access to antiretroviral treatment. Condoms "need to be provided free in sufficient quantities," and health care workers need to "understand and address the reasons" why HIV-positive people continue to have unprotected sex even when condoms are available and they have received HIV/AIDS prevention information, the authors say. If health care workers do not gain such understanding, "they will become frustrated and programs will remain ineffective," the authors conclude (Wilson et al., Lancet, 9/18).