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Complacency on
AIDS
~~article_author~~ NYT
Monday, June 14, 2004
A few years after the antiretroviral cocktail became available in
1996, turning AIDS from a death sentence into a chronic disease,
unsafe sexual practices began to surge in the United States and
Europe. For example, new diagnoses of the AIDS virus in the United
States, which had been steady, rose 5 percent from 1999 to 2002, with
a 17 percent rise among gay men.
Antiretroviral drugs are still a dream for the vast majority of the
world's infected. Only 7 percent of those who need treatment outside
rich countries get it, about 400,000 people. But that number is
likely to be in the millions soon, and it is crucial that the same
pattern witnessed in the developed world - better treatment
apparently leading to rising AIDS infection rates - not repeat itself
in poorer nations.
A new report from the Global HIV Prevention Working Group, an
organization of more than 40 AIDS experts from around the world,
warns of this potential danger. It also points out the many ways that
AIDS treatment can assist prevention campaigns. Nations like Brazil
that have emphasized treatment and prevention simultaneously should
serve as a model.
The availability of treatment can lead to infection in several ways.
Sick people restored to health by antiretroviral drugs have more
opportunity to pass along the AIDS virus , as they live longer and
feel well enough to be sexually active. In rich countries, some
people who are living well with AIDS have become less careful in
their sexual behavior. Governments, for their part, tend to become
more casual about prevention campaigns as treatment becomes more
available.
Treatment need not push out prevention. In Khayelitsha, a slum
outside Cape Town where Médecins Sans Frontières provides
antiretroviral drugs, demand for testing and counseling rose
exponentially when treatment became available, as people suddenly saw
a reason to find out their HIV status. People who get counseling are
far more likely to reduce risky sexual behavior.
Treatment should lead to more, rather than less, talk of prevention.
The availability of treatment reduces the disease's stigma, making it
easier for people to discuss AIDS and be receptive to messages of
prevention. Where AIDS is always fatal, on the other hand, it is
shrouded in denial.
But to reap these advantages, the world must invest far more in
prevention. Only 12 percent of people who need testing and counseling
have access to these services. Condoms are also scarce. Perhaps the
report's most shocking statistic is that the supply of condoms in sub-
Saharan Africa can provide each adult man with only three a year.
Messages about prevention and condoms need to be ubiquitous, the
group concludes. Clinics that serve people at risk for AIDS,
including prenatal and tuberculosis clinics, should offer AIDS tests,
counseling, condoms and information about how and why to avoid
infection. Those on antiretroviral therapy should also be getting
safe-sex messages with every contact with the health system.
Training and employing counselors takes money, as does AIDS
prevention research and assuring an adequate and reliable supply of
condoms. But increased resources for prevention, carefully spent,
will complement new AIDS treatment programs, together saving tens of
millions of lives.
Copyright © 2004 The International Herald Tribune |
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