London – As World AIDS Day is marked today, some public-health experts are saying the current focus on universal access to lifesaving antiretroviral drugs has had an unintended effect: sidelining prevention. Without a vaccine, preventing HIV infections is key to controlling the pandemic.
New strategies that attempt to change the very environment of AIDS transmission are now being considered. A study published online Thursday in the British medical journal The Lancet describes how a microfinance project in South Africa cut women’s chances of domestic violence by more than half.
There is a strong link between HIV transmission and abusive relationships, with abusive men more likely to have multiple partners or to become violent if asked to use condoms.
“If you address the broader risk environment, women and communities can be quite creative in finding solutions,” said Dr. Julia Kim, one of the Lancet study’s authors.
In the study, 430 women in rural South Africa were loaned money to start small businesses. Most women sold fruit, vegetables or clothes, or offered tailoring services. With economic and social independence, women were no longer obligated to remain in violent relationships.
Rates of HIV infection continue to grow, with 4 million new cases worldwide every year. The battle continues to be waged even in countries that were previously models of control. Because of erratic condom use and the virus’ spread into new populations, such as married women, HIV has made a worrying return to countries such as Thailand and Uganda.
“We need to run faster to get ahead of the virus,” said Jennifer Kates, vice president and director of HIV policy at the Kaiser Family Foundation, an independent U.S.-based organization that works on AIDS issues worldwide. Because the AIDS outbreak is accelerating, so too must the public-health response.
Dr. Purnima Mane, a senior UNAIDS official, estimates that public-health officials need to plan for at least the next two decades before seeing a substantial decline.
There is no one-size-fits-all solution.
Only in sub-Saharan Africa is AIDS really hitting the general population. In the rest of the world, intravenous drug users, prostitutes and gay men are at highest risk.
