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Science Examines HIV/AIDS Prevention, Treatment Strategies Discussed at Last Week's Conference in Mexico City |
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Science Examines HIV/AIDS Prevention,
Treatment Strategies Discussed at Last Week's Conference in Mexico City |
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| The journal Science in its Aug. 15 issue
examined the "intense scrutiny" that HIV/AIDS prevention and treatment
received during last week's XVII International AIDS Conference in Mexico
City. Mike Cohen of the University of North Carolina-Chapel Hill at the
conference said the two efforts "keep going to the altar," but "[t]hey never
get married. They have to get married today." According to Cohen and other
delegates at the conference, although there have been considerable gains in
HIV/AIDS treatment, such efforts have overshadowed prevention needs. Science
reports that three million people in low- and middle-income countries now
have access to antiretroviral drugs but that an estimated five people
contract HIV for every two provided with treatment. UNAIDS Executive
Director Peter Piot said, "There has not been that push for prevention as
there's been for treatment," adding, "If we thought the first phase was
hard, we have to prepare for even tougher times. "Science reports that a
significant issue surrounding treatment and prevention is that the success
of antiretrovirals in lowering viral loads and making HIV-positive people
less infectious has led to the "increasing awareness that treatment is
prevention, both for individuals and populations." However, "the degree to
which the drugs can prevent infections has proved highly contentious,"
according to Science. For example, a study by the Swiss Federal Commission
for HIV/AIDS concluded that couples with one HIV-positive partner do not
need to use condoms to prevent HIV transmission provided that the
HIV-positive person is taking antiretrovirals, has had an undetectable viral
load for six months and has no other sexually transmitted infections. Kevin
de Cock, head of the World Health Organization's HIV/AIDS Department, said,
"It just doesn't seem like a cautious public health recommendation," adding,
"I don't think anyone's shown the threshold below which people cannot
transmit" HIV. Further contention surrounding treatment and prevention at
the conference, according to Science, included the degree to which ongoing
treatment can prevent transmission on a population-wide scale. Although a
study published in the Canadian Medical Association Journal found that
treatment led to a decrease in HIV transmission in the province of British
Columbia, epidemiologist Geoffrey Garnett of Imperial College London said
that antiretrovirals are unlikely to have a large effect on transmission on
a global scale. About 80% of HIV-positive people are not aware of their
status, and of those who do, most are not eligible for no-cost treatment
until their immune systems have been damaged. According to Science, this
means that most HIV transmissions "occur long before people are taking the
drugs." Garnett and others encouraged HIV/AIDS researchers to embrace the
notion of "combination prevention." According to Garnett, by combining
treatment with preventive measures, such as condom use and male
circumcision, it might be possible to create "a natural synergy." He added,
"Rather than arguing for a single magic bullet, we really need to be trying
to focus everything that we can on what works to realize these natural
synergies" (Cohen, Science, 8/15). Kaisernetwork.org was the official
webcaster of the XVII International AIDS Conference in Mexico City.
Kaisernetwork.org interviews with Science correspondent Jon Cohen during the
week of the AIDS conference are available online. Access this story and related links online: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=53977 |
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