Experts Urge Integrated AIDS Strategy

A report published in advance of the International AIDS Conference in Bangkok next month cited an unprecedented opportunity to integrate HIV prevention with treatment programs in poor countries, where most of the infections currently are.

"This is the best chance the world has had to build a comprehensive response to the global epidemic," said Dr. Helene Gayle, co-chair of the Global HIV Prevention Working Group, an international panel of nearly 50 AIDS experts, which published the report. "More widespread access to treatment is likely to bring millions of people into health care settings, providing new opportunities for health care workers to deliver and reinforce HIV prevention messages," Gayle said.

As the epidemic evolved in developed countries, governments tended to emphasize treatment rather than prevention. As HIV became a manageable disease with the arrival of potent antiretrovirals, complacency set in, according to studies. Some populations decreased condom use, other risky habits returned, and infection rates began to rise.

"If you look at budgets around the world, when treatment is introduced, often times it becomes increasingly the larger part of the budget and prevention spending stays flat or even decreases," Gayle said.

Only about 7 percent of people in poor countries who need HIV medicine are getting it. The World Health Organization aims to get 3 million people in the developing world on HIV medications by 2005. Experts say the need to integrate prevention with treatment programs is well recognized, but without the proper coordination of the two approaches, the fight against HIV/AIDS will be more difficult.

"I'm optimistic," Gayle said, "because I think we have lessons to learn. We have history to show us that prioritizing treatment over prevention in the long run won't get us there."

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