International Community Must Adopt Integrated HIV Prevention, Treatment Efforts, BMJ "Education and Debate" Article Says

In order to stem the spread of HIV, the international community must adopt a comprehensive strategy that integrates prevention and treatment efforts, a group of AIDS experts writes in an "Education and debate" piece in the Nov. 8 issue of BMJ. The authors included Joia Stapleton Mukherjee, an associate physician at the Department of Social Medicine & Health Inequalities of Brigham and Women's Hospital; Paul Farmer, a Harvard Medical School professor and founder of the nongovernmental health care organization Partners in Health; Deogratias Niyizonkiza, research assistant at DSMHI; Laurel McCorkle, staff assistant at DSMHI; Chris Vanderwarker, research assistant at DSMHI; Paulo Teixeira, director of HIV/AIDS at the World Health Organization; and Jim Yong Kim, senior adviser to WHO Director-General Dr. Jong-Wook Lee. Prevention by itself does "nothing to improve the quality or length of life" for HIV-positive people, and 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," the authors say. Treatment can provide an "avenue of contact" with health workers, "who can reinforce prevention messages," the authors say, adding that mathematical modeling shows that secondary prevention efforts are crucial in preventing the spread of HIV. Another crucial component of successful HIV prevention programs is access to testing and counseling services, and the availability of treatment increases the demand for such services, they write. Therefore, it is important that the international community recognize the "mutually reinforcing" relationship of treatment and prevention programs, and work to implement a "comprehensive global AIDS strategy" (Mukherjee et al., BMJ, 11/8).

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