Commentary & Opinion
Lancet Publishes Opinion Pieces on HIV Prevention, Epidemic in China
November 25, 2008
The Lancet on Saturday published two editorials about HIV prevention and China's HIV/AIDS epidemic. Summaries appear below.
- Merson et al., Lancet: According to Michael Merson of the Duke Global Health Institute and colleagues, HIV prevention cannot be limited to just "one or two stand-alone" measures such as male circumcision or partner reduction. Although such prevention measures are effective and important in the fight against HIV/AIDS, they must be used in combination with other measures, and prevention efforts must "address immediate risk settings as well as social norms and regulatory environments," the authors write, adding, "No quick fix can substitute for the sustained political will needed to ensure these populations are not dehumanized." According to the authors, "Our call to action to fully implement combination prevention is framed in terms of accepting its complexity: neither paralyzed in the face of vast social inequities nor tempted by magic bullet solutions. A revitalized HIV prevention movement needs to move beyond its fixations about whether any specific intervention is more important than the other while ignoring how to achieve them." The authors write, "If we really want to advance the effectiveness of HIV prevention, we have to disabuse ourselves of the notion that the epidemic can be conquered by a single best intervention." They conclude, "Rather, we must focus on scaling up combination efforts and on building the evidence base for which mixes produce maximum effect in which settings" (Merson et al, Lancet, 11/22).
- Zhang et al., Lancet: Kong-Lai Zhang of the Institute of Basic Medical Sciences in Beijing and colleagues detail the measures they believe can prevent and treat HIV/AIDS in China, where the disease largely affects low-income and marginalized groups. According to the authors, there is a need for promotion of condom use, needle-exchange programs, and local clinics and laboratories that can provide second- and third-line antiretroviral drugs, as well as specialized expertise. HIV-positive people also must be taught the importance of adhering to antiretrovirals, and those at risk of contracting the virus -- such as men who have sex with men and commercial sex workers -- should be taught proper prevention measures. The authors write, "To stop the spread of the epidemic, additional changes to HIV/AIDS policies, as well as better coordination and implementation of programs, need to be made. HIV/AIDS prevention and care need to be incorporated into routine practices in health care, public health programs, and medical and nursing education to guarantee an effective, efficient and sustainable response. China also needs to mobilize and engage civil society in the fight against HIV/AIDS and to encourage interdisciplinary approaches for HIV research, treatment, care and prevention." They conclude, "We are confident that China will continue to meet the challenges" (Zhang et al. Lancet, 11/22).
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