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Can we really stop Aids in 5 years?

February 23, 2010

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So… Anti-retrovirals (ARVs) could halt the spread of Aids in five years, eh? So says the headline on the BBC website. The version of the story told by CNN is rather more in-depth.

The first thing I noticed about this headline was the focus on halting the spread of Aids, not the spread of HIV which leads to Aids. It’s only a small detail, but I think it’s an important one.

Dr Brian Williams, a leading light in HIV research, spoke at the American Association for the Advancement of Science (AAAS) in San Diego last Saturday (20th Feb), and presents an interesting argument.

He suggests that we look at ARVs as a method for preventing transmission of HIV, rather than focussing solely on slowing the development of Aids. It’s early days yet, and he’s calling for more trials, but the suggestion seems sound (to me – with my vast experience of no medical knowledge).

The idea is that by introducing ARVs earlier, the viral load of the HIV+ individual can be reduced to almost nothing – which makes it highly unlikely that they will pass it on to anyone else. At the moment, patients need to have reached a certain count before they’re allowed access to the ARVs. Williams suggests that by the time most of them start, they have already infected “most of those that they would have infected anyway.” If people with HIV were given access to ARVs earlier, it would reduce the size of the window in which they can infect others. Williams suggests that if the trials start now, within five years all those living with HIV in South Africa could be on ARVs. Given time for it to work through, this would dramatically reduce the rate of transmission in the country.

Dr Williams knows his stuff. He’s been an epidemiologist for the WHO and helped set up the South African Centre for Epidemiological Modelling and Analysis (Sacema) in Stellenbosch. And he’s not suggesting that this could be The Cure. The ongoing search for the elusive vaccine must continue, but it’s a long way off and this strategy should complement that work not replace it. His contemporary Kenneth Mayer, professor of medicine at Brown University, Rhone Island, agrees with him. Early access to ARVs is, he says, a matter of “public health.”

It’s a great story, a new approach to a difficult and intractable problem. I would dearly love to be trumpeting this story and waxing lyrical about the impact it will have on the face of sub-Saharan Africa – not just South Africa. But I just don’t think it will be that simple.

For me, one of the biggest difficulties will be getting past the stigma. It’s all very well introducing ‘universal’ testing, but people need to present at a clinic/testing centre in order to access it. HIV and Aids carry heavy stigma here, as they do in many other parts of the world. And it’s human nature to avoid bad news as long as you can.

I’ve been here less than six months, but I have already heard of someone who died from HIV related illness, because they refused to get tested and treated. Their partner was “on the medication” already – it’s not as though the clues weren’t there. But this person did not want to know. It’s sad, for the family and friends left behind, but personal health issues are just that. Personal. And whilst HIV and Aids and TB and Malaria and STIs and teen-pregnancy and everything else might be ‘public’ health issues, when you get to the individual they are personal. The choice to seek or accept treatment is a personal one, one that can only be taken by the individual.

Which is not to say we shouldn’t be trying – we absolutely must! The work of Dr Williams et al is vital, and should be supported as much as possible. But medical advances alone are not going to solve this problem. For the record – I don’t think he’s saying that they will, but I think it’s a point that needs to be stated explicitly. Headlines like the one at the top of this story make people feel better about the fight, they stop people worrying as much about the problem which won’t go away.

We can’t afford to do that.

We need to increase education programmes, we need to foster behaviour change, we need to encourage people to understand that their sexual health is something they can and should take control over and take a stand to protect. We need to develop policies that protect ‘at risk’ groups, and ensure they’re enforced. We need to look at the problem holistically and push every option as far as it will go. And we need to keep doing what Dr Williams is doing – looking at things from other angles, suggesting other ways of doing things.

I’m not just talking about here in Botswana, or even just in sub-Saharan Africa. I’m talking about everywhere. HIV is not just a global problem. It’s an individual one.

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