2008 International AIDS Conference
One-Size-Fits all Prevention Wrong Fit for HIV/AIDS Epidemic
By Linda Villarosa
Visit Black AIDS Institute´s Youtube page. MEXICO CITY -- At past international AIDS conferences, a session on prevention wouldn’t have drawn enough attention to fill a large meeting room. In previous years, treatment dominated the conversation. But this year the theme of prevention has bubbled to the surface among the tangle of panels and workshops, debates and discussion among the 22,000 attendees. Tuesday’s morning plenary on the topic was filled to capacity and several other sessions hummed with interest and energy. Later, at the Lancet Series on HIV Prevention session, hundreds of people packed into the session room and many others stood outside, unable to get in. And it’s not just prevention as usual. Throughout the conference, scientists and activists have called for new ways to staunch the spread of HIV throughout the world. Last year, 2.7 million people were newly infected, most in sub-Saharan Africa. “Prevention has not only been marginalized, but in some places it’s been suppressed for political, religious or social purposes, said Richard Horton, editor of The Lancet, the British medical magazine that devoted its most recent issue to HIV prevention. “We have to redefine prevention, to create a new dialogue of what we mean by prevention.” Combination prevention is the hot new buzzword. This means simply, combining various prevention strategies to decrease the spread of HIV. Too often the prevention framework is one size fits all. Hand out condoms and call it a day. Or, in the United States, fund only prevention programs that teach abstinence to the exclusion of comprehensive sexual health education. Or the latest magic bullet: circumcision, which has been shown to reduce by 60 percent the spread of HIV from women to men during heterosexual intercourse, mostly in Africa. But what about the other 40 percent? And what about male to female transmission and male to male—by far the more common forms of transmission in the United States? Circumcision, condom distribution or abstinence education in isolation is not and has never been the answer. Strategies for the following categories also must be developed: • Comprehensive sexual health education, including abstinence, negotiated safety, partner reduction and proper condom usage. • Risk reduction for HIV drug users, including needle exchange programs and other harm reduction strategies. • HIV testing and counseling to reduce the number of people who don't know they've been infected. • Access to preventive health care for everyone. • Human rights and social justice for all, including equal rights for women and lesbian, gays, bisexuals, transgendered people and those living with HIV/AIDS. • Treatment and care for people living with HIV and AIDS. “There will never be a single magic bullet to prevent HIV transmission,” says Nancy Padian, executive director of the Women’s Global Health Imperative in San Francisco. “A combination prevention packages is what’s most effective.” African Americans have a complicated tangle of factors that make them more susceptible to HIV and demand, thoughtful, textured and often costly prevention efforts. “Prevention can’t be about telling people not to have sex,” says Ebony Johnson, a Washington, D.C. activist who mobilizes women to advocate for better HIV treatment and care. “If you tell people not to have sex they’re not going to listen. How can you tell a married woman not to have sex with her man? That doesn’t make any sense, that isn’t a strategy.” Other HIV prevention methods have also proven ineffective or incomplete. How does a woman ask a man she’s been with for two years to suddenly wear a condom even if she suspects he’s been unfaithful? Or, what if her husband’s recently returned from prison? Asking him to wear a condom says, “I think you had sex with a man while you were inside, or worse, got raped.” Says Dr. Helene Gayle, a long-time HIV expert and president and CEO of CARE USA. said, “Black America needs a broader and more intensive mix of prevention initiatives, including initiatives that are designed by Black Americans in the Black community.”