Refocus on Prevention and Education to Make Progress on AIDS, Say U.S. Scientists

Preventing new infections should be the priority of the long-term response to HIV/AIDS in Africa, according to a recent U.S. Institute of Medicine (IOM) report.

In 2008, more than 33 million people had HIV/AIDS globally, including 22.4 million in Africa. "More than 90 percent of the 2.7 million new infections reported that year occurred in Africa," the institute noted in a statement. "By 2020, the number of infected people in Africa will grow to over 30 million, with just 7 million of the approximately 12 million who should be treated under current guidelines likely able to receive ART [antiretroviral therapy]," estimated the IOM committee that authored the report.

Though the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) requires the nations it assists to have a five-year HIV/AIDS strategy, the IOM report urges target countries to adopt a 10-year view.

The long-term costs of treatment are "not sustainable for the foreseeable future," the report states. "Already in Uganda and a few other nations, we don't have enough health care workers or ART to meet demands, and health centers are increasingly turning away patients who need these drugs to survive," said David Serwadda, professor and former dean of Makerere University's School of Public Health in Kampala, and IOM committee co-chair. "There is an urgent need for African countries and the U.S. to share responsibility and initiate systematic planning now for the future. If we don't act to prevent new infections, we will witness an exponential increase in deaths and orphaned children in sub-Saharan Africa in just a couple of decades."

"I am deeply disappointed with this report," said Greg Gonsalves, a treatment activist who has worked in the United States and southern Africa. "It looks like it could have been written 10-15 years ago. It's a capitulation to the old guard in health and development ... [that led to] crumbling health systems, dead mothers and babies, new epidemics and revivals of old ones."

Scaling up treatment "has not been rapid enough to solve the problems of this epidemic, and we have come full circle, back to the emphasis on prevention," said committee member Mead Over of the Center for Global Development in Washington. Incentives should be used to encourage HIV prevention, he added.

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