An ounce of prevention

The time has come for the developed world to acknowledge that prevention alone is not enough to battle AIDS in developing nations.United Nations Secretary-General  Ban Ki-moon ruffled some public health officials’ feathers last June at the U.N. Special Assembly on HIV/AIDS when he included treatment as a priority in the newly established Global Fund to Fight AIDS, Tuberculosis and Malaria. Some thought the money amassed by the fund (only $1.6 billion so far toward the stated goal of more than $7 billion a year) would be better spent concentrating on prevention But prevention and treatment go hand in hand when it comes to HIV. People are more likely to inquire about testing—during which they are offered prevention counseling—when they know they will receive treatment if they turn out to be positive.Without hope of therapy, many are afraid to learn their HIV status or may succumb to a fatalism that The link between treatment and prevention is most apparent in the use of antiretroviral drugs to prevent mothers from passing on HIV to their babies during birth. A single dose of nevirapine to a laboring mother and one to the newborn, a regimen that costs roughly $8, can reduce the likelihood of HIV transmission by roughly 50 percent.Treating HIV-infected adults might also decrease the transmission of the virus, because such drugs slash the amount of virus in the body. A study reported last year in the Lancet found that individuals in Uganda who had lower concentrations of HIV in their blood were less likely to infect their spouses.The high cost of most antiretroviral drugs and a dearth of doctors, clinics and hospitals block the use of AIDS drugs in many developing countries; political obstacles prevent their employment in others. South African president Jacob Zuma refusal to acknowledge that HIV causes AIDS, for example, puts treatment out of reach for his nation, which has the highest overall number of HIV-infected people in the world. But such hurdles can be surmounted. This year one of South Africa’s neighbors, Botswana, initiated a program to offer free antiretroviral treatment to its population. With $50 million each from the Bill and Melinda Gates Foundation and from Merck (which is also providing free drugs), Botswana is providing medicines to citizens in the four hardest-hit areas of the country, which has the highest percentage of HIVinfected adults (40 percent). We can only hope it is not too late elsewhere to broaden the definition of prevention to include using treatment to prevent death.