Jul 27, 2010

The Time Has Come for HIV/AIDS Prevention

by Laura Starita

Last week’s 18th International AIDS Conference in Vienna brought some mixed news. 

First some good news: A vaginal microbicidal gel was found to be 39 percent effective at preventing HIV infection in women volunteers in a trial in South Africa. Effectiveness rates rose to 54 percent for those who used the gel most diligently.  These results have generated a great deal of enthusiasm after many years of stymied efforts to find pharmaceutical prevention aids. Past trials of microbicides and vaccines have produced disappointing results, despite the volume of prevention funding that goes into research and trial for pharmaceutical approaches. Part of what is truly promising about the gel is that a woman can insert it 12 hours before having sex and her partner likely won’t even know about it. It will be years before the gel is commercially available, however, and more testing will need to be done to determine the right dosage, effectiveness of combination medications and other outstanding issues.

Another randomized trial sponsored by the World Bank tested the effect of conditional cash transfers on HIV infection rates among young girls in Malawi. The poor girls and their families in the treatment group were given payments of up to $15 a month, so long as the girls went to school. More of the girls stayed in school in the treatment group that in the control group, but a bonus was that at the end of the study the HIV infection rates among those who received payments was less than half the rate of participants who received no cash payments (NB: The study write up did not clarify what the infection rate was across treatment and control at the outset of the study, and so I am assuming they actually included bio-marker data in the baseline—a possibly large assumption. I am following up and will report back!). The operating assumption was that the girls who received payments were less likely to have sex with older men in order to receive gifts or cash. The CCTs shifted their economic calculations, and protected them from the much higher infection rates that older men in Malawi have.

This good news comes at a time of relative despondency in the battle against HIV/AIDS. Funding from major government and individual donors has declined dramatically during these lean economic times. Despite significant successes in bringing treatment to more infected people, the virus continues to spread, with far more people becoming newly infected than there are resources to treat them. We have written often about the importance of prevention in the fight against AIDS, but that battle is still being fought, without many unequivocal successes. Even countries with relatively controlled epidemics are seeing some depressing statistics: Infection rates among people over 55 in both the United States and the United Kingdom more than doubled between 2000 and 2007, a consequence of high divorce rates and complacency.  These results offer some light in the dark—two potential approaches toward effective prevention.