AIDS Alert International: African prevention efforts yield hope for future
Small successes could be model
HIV prevention continues to offer the world’s best hope in stopping the AIDS epidemic, and recent success stories in South Africa and Uganda prove that these work, according to the recent AIDS Epidemic Update report by UNAIDS and the World Health Organization (WHO) in Geneva, Switzerland.
"We should not forget that delay of infection, a delay of one year, could cause the avoidance of another five million deaths," says Bernhard Schwartlander, MD, PhD, HIV/AIDS director for WHO.
Prevention efforts in South Africa have resulted in a significant drop in HIV prevalence rates among pregnant women under age 20, the report says.
In 1998, that group’s HIV prevalence rate was 21%, while in 2001 the HIV prevalence rate had fallen to 15.4%. Syphilis rates among pregnant women also had fallen from 11.2% in 1997 to 2.8% in 2001, according to the report, which attributes the decline to prevention efforts and education. The report also notes that HIV infection rates continue to rise among older pregnant women.
Prevention efforts also are credited with a decline in HIV prevalence among inner-city women ages 15-24 who attend antenatal clinics in Addis Ababa, Ethiopia. The infection rate dropped from 24.2% in 1995 to 15.1% in 2001, the report says.
However, the greatest evidence of prevention’s impact on HIV prevalence can be found in Uganda, where HIV prevalence among pregnant women ages 15-19 has dropped steadily in recent years. Also, condom use among single women of the same age group nearly doubled between 1995 and 2001, and there was evidence that women in that age group had delayed or abstained from sexual intercourse, the report says.
While the drops in HIV prevalence are a positive sign that prevention works, these small successes only point to a strategy — not to a blueprint — for turning the epidemic around, because the prevention programs that work with certain populations in Uganda and South Africa may not be suitable for other populations in those countries or in other nations. There is no single prevention program that will work for all purposes, Schwartlander says.
Prevention works when it results in a mixture of postponement of first sexual intercourse, increased condom use, a decrease in sexual partners, and fewer commercial sex encounters for men, Schwartlander says.
"So it’s an illusion to think one intervention will fix this epidemic, and that’s one of the main messages," Schwartlander says.
Another aspect of prevention involves making testing and counseling accessible to everyone at risk in developing countries, and that goal still remains elusive in most of sub-Saharan Africa, says Peter Piot, MD, executive director of UNAIDS.
"Worldwide, most people who are infected don’t know they’re infected," Piot says. "Testing and counseling are a priority for prevention."
However, it is difficult to convince people in developing nations to be tested for HIV, even when it is available, when there is no available treatment. Thus, the world’s wealthier nations need to invest more in treatment efforts among poor nations, and this will help to improve prevention, as well, Piot says.
HIV prevention continues to offer the worlds best hope in stopping the AIDS epidemic, and recent success stories in South Africa and Uganda prove that these work, according to the recent AIDS Epidemic Update report by UNAIDS and the World Health Organization (WHO) in Geneva, Switzerland.
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