Experts say time to change strategies for HIV prevention in Africa

May 12 2008

Experts on HIV/AIDS are calling for a change of strategies in dealing with HIV prevention in African countries.

Two-thirds of HIV infections globally occur in Sub-Saharan Africa which has high rates of HIV infection and the experts say current funding for HIV prevention which promote strategies such as condom promotion, HIV testing and vaccine research have had limited success in Africa and a "dramatic shift" in priorities is needed.

The researchers say while promotion of condom use can have success in high-risk populations, such as gay men and sex workers, they believe that condom use has not lead to a significant reduction in new HIV infections in countries with generalised epidemics.

The researchers from the Harvard University School of Public Health say the evidence behind many of the prevention strategies used in African countries with "generalised" heterosexual HIV epidemics was weak

Dr. Daniel Halperin, the study leader, says promoting male circumcision and the reduction of multiple sexual partners should become the "cornerstone" of prevention.

The researchers say in nine southern African countries, more than 12% of adults are infected with HIV, and the widespread promotion of condom use has not had a measurable effect on new infections.

Their review of the research found several studies have shown no consistent reduction in risk of new infection associated with HIV testing and the evidence for treating other sexually transmitted infections to reduce HIV transmission is also minimal.

Dr. Halperin says many studies have shown that male circumcision significantly reduces the risk of heterosexual HIV infection and three trials in Africa were stopped early after showing at least a 60% reduction in HIV risk.

Dr. Halperin also says that programmes to promote fewer sexual partners appear to have had a primary role in reducing HIV/AIDS rates in Uganda, Kenya, Zimbabwe, Cote d'Ivoire, and in urban Malawi and Ethiopia.

He says a 1987 "Zero Grazing" campaign in Uganda, resulted in the number of people reporting multiple and casual partners had declined by over half.

Dr. Halperin who is a lecturer in International Health says despite large investments for years in African HIV/AIDS prevention, it is clear that a better job in reducing the rate of new HIV infections must be done.

UNAIDS says HIV/AIDS was and still is an emergency requiring an "unprecedented response" and even the best health services in the world cannot tackle HIV/AIDS alone.

Experts say HIV/AIDS funding can and does bolster health systems but different strategies are needed for different countries.

The paper is published in the current edition of Science.