Nearly 150 HIV/AIDS Experts in Lancet Commentary Call for Consensus on Approach To Preventing Sexually Transmitted HIV
HIV/AIDS experts from around the world in a commentary published in the Nov. 27 edition of the journal Lancet call for consensus on a "sound public health approach" to preventing sexual transmission of HIV. The piece, which was published to mark World AIDS Day on Dec. 1, is endorsed by nearly 150 experts from 36 countries. Although sexual behavior is influenced by many factors, the public health community "has an obligation to offer people the most accurate information on how to avoid HIV and to encourage changes in societal norms to reduce the spread of the virus," according to the commentary. The piece calls for an end to the "polarizing debate" over prevention and urges experts to come to a consensus on an "inclusive evidence-based approach" to prevent the spread of HIV. The commentary suggests some "key principles" for successful prevention programs. First, programs need to be "locally endorsed" and epidemiologically grounded. Second, programs should employ the ABC approach -- abstinence, be faithful and use condoms -- with emphasis on each of the elements depending on the target population. Third, community-based prevention programs should involve religious groups, women's and men's organizations, youth organizations, care groups, health care workers, local media, and traditional and governmental leadership to "foster new norms of sexual behavior" and reduce stigma, gender inequality, sexual coercion, cross-generational sex and transactional sex, according to the commentary. The piece concludes that it is "time to leave behind divisive polarization and to move forward together in designing and implementing evidence-based prevention programs to help reduce the millions of new infections occurring each year" (Halperin et al., Lancet, 11/27).
The Nov. 27 issue of the Lancet includes several other commentaries on HIV/AIDS, including:
- "From a Vicious Circle to a Virtuous Circle: Reinforcing Strategies of Risk, Vulnerability and Impact Reduction for HIV Prevention": Catherine Hankins of the social mobilization and strategic information department of UNAIDS writes that UNAIDS supports the consensus approach to preventing sexual transmission of HIV, but she notes that it is "equally critical to mount broad strategies that address vulnerability to HIV exposure -- i.e., the inability of individuals to control their risk of infection because of contextual factors that create situations of risk" (Hankins, Lancet, 11/27).
- "The Imperative for Family Planning in ART Therapy in Africa": James Shelton and Anne Peterson of USAID write that while efforts are under way to provide antiretroviral drugs on a "grand scale" in Africa, "important issues such as family planning risk being overlooked." Shelton and Peterson add that family planning is "crucial -- not only for the well-being of women and children but also as a potent instrument to combat AIDS" (Shelton/Peterson, Lancet, 11/27).
- "Opioid Substitution and HIV/AIDS Treatment and Prevention": Thomas Kerr of the British Columbia Centre for Excellence in HIV/AIDS and colleagues write that the implementation of antiretroviral treatment programs has been impeded in some settings by the "significant problems resulting from untreated opioid dependence" and that increased integration of opioid substitution therapies -- including the drugs methadone and buprenorphine -- could help "bring the HIV/AIDS epidemic among [injection drug users] under control" (Kerr et al., Lancet, 11/27).
- "Why AIDS in South Africa Threatens Stability and Economic Growth in Other Parts of Africa": Jerome Singh of the Centre for the AIDS Programme of Research in South Africa writes that the "AIDS pandemic will likely not only threaten South Africa's prosperity and population growth but could also compound the threats posed by AIDS, poverty and military conflicts in many other parts of the African continent." Singh adds that a "nuanced understanding of how the AIDS pandemic is affecting or could affect a regional power's economy and military, and the weight of these factors on a region, could mitigate future regional economic and security crises" (Singh, Lancet, 11/27).