Tuesday, 8 April 2008

AIDS and the Churches: Getting the Story Right

[...] Thus far, research has produced no evidence that promotion—or indeed any of the range of risk-reduction interventions popular with donors—has had the desired impact on HIV-infection rates at a population level in high-prevalence generalized epidemics. This is true for treatment of ually ­transmitted infections, voluntary counseling and ­testing, diaphragm use, use of experimental l microbicides, safer-sex counseling, and even income-­generation projects. The interventions relying on these measures have failed to decrease HIV-infection rates, whether implemented singly or as a package. One recent randomized, controlled trial in Zimbabwe found that even possible synergies that might be achieved through “integrated implementation” of “control strategies” had no impact in slowing new infections at the population level. In fact, in this trial there was a somewhat higher rate of new infections in the intervention group compared to the control group.

The one medical intervention that has now been proven effective according to the highest standards of scientific research is male circumcision, which reduces a man’s risk of HIV transmission by more than half. Lack of male circumcision, along with high rates of long-term concurrent ual partnerships, likely accounts for the hyperepidemics of southern Africa. But even many advocates of male circumcision believe that it needs to be promoted along with partner ­reduction.

Meanwhile, the other interventions that have generally been called “best practices” simply do not seem to work in generalized epidemics, even though they are still applauded loudly at global AIDS conferences, while mention of fidelity and abstinence is received by booing, as Bill Gates discovered at the International AIDS Conference in Toronto in 2006. If we are to progress beyond science-by-popular-acclaim, we must accept that the evidence is much stronger for fidelity or partner reduction than for any of the standard-package HIV-prevention measures—in Africa at least—and so we need to rethink and reprogram AIDS-prevention interventions. Read more
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