Tackling HIV in resource poor countries

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Abstract
Why prevention is not enough Prevention of HIV infection is often promoted as the only feasible option in resource poor settings despite the existence of drugs to treat it. As recently as 2002, experts argued that prevention should take priority over treatment for AIDS in Africa based on cost effectiveness.1 2 However, cost effectiveness analyses fail to take into account the most important reason for implementing widespread HIV treatment–treating sick people. Prevention strategies do nothing to improve the quality or length of life of the millions of people living with HIV. Moreover, the unchecked spread of HIV is resulting in indirect costs, ranging from orphaning to famine and from stigma to professional burnout, that are damaging already heavily burdened societies. A poignant example of the shortcomings of the focus on prevention is the practice of prioritising the use of antiretroviral therapy for prevention of mother to child transmission without giving the drugs to mothers who are sick. Although this strategy protects babies, their untreated mothers develop AIDS and die. Clearly, both prevention of mother to child transmission and treatment of HIV positive parents are needed to protect the family and community. Patients with AIDS in a hospital in Mumbai, India Credit: P VIROT/WHO A comprehensive global AIDS strategy that links prevention to treatment is needed to save the lives of the 42 million people living with AIDS and to stop the humanitarian disaster that is being fuelled by the epidemic. Thailand and Uganda are often cited as models for HIV prevention and are unique because of their strong political commitment and the early implementation of HIV testing.3–5 Yet of 11 major randomised controlled trials that examined the effectiveness of HIV information, education, and communication interventions, none showed any effect on the epidemiology of the HIV epidemic.6 We are not arguing that prevention strategies should be abandoned but rather that prevention and treatment must be closely linked and strengthened to combat HIV and AIDS. Acknowledgments Contributors and sources: All information in this paper was collected from peer reviewed journals, international agency reports, and experience of Partners In Health in Haiti and the Ministry of Health in Brazil. JSM has worked since 1991 on the HIV epidemic in Kenya and Uganda and for the past four years in Haiti with Partners in Health. PF and PT have each had 29 years of experience in the HIV epidemic through Partners in Health in Haiti and the Brazilian National AIDS programme respectively. JYK has been involved in policy development for WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria and is involved in the WHO 3 million by 2005 campaign to accelerate access to antiretroviral drugs. CV, LM, and DN did the background research.