Door-to-Door HIV Testing, Married Couple Counseling Among Prevention Efforts Needed, PEPFAR Conference Participants Say

Although access to antiretroviral drugs has been the primary focus of U.S. efforts to fight global HIV/AIDS, prevention efforts must increase, according to health care workers attending the second annual meeting of President's Emergency Plan for AIDS Relief field workers last week in Addis Ababa, Ethiopia, the Boston Globe reports. Prevention became a major issue at the conference "because a strong undercurrent of Washington politics could be felt ... and because of fears that no one was paying enough attention to breaking transmission of the virus," according to the Globe. In order for prevention efforts to be successful, people first must know their HIV status, and the results of two studies suggest that conducting HIV testing at people's homes might be effective, according to the Globe. One study conducted in Western Uganda found that 94% of 10,000 residents who were visited in their homes by a health care worker agreed to take an HIV test. U.S. AIDS experts and African leaders attending the conference said they will begin formulating door-to-door prevention programs. "If we want to get more people tested and more people on treatment, this is low-hanging fruit," Rebecca Bunnell, CDC's director of science in Uganda, said, adding, "It gives us a comprehensive look at the entire family." U.S. officials are hoping that the World Health Organization will approve an oral HIV test in the next few years. Although rapid blood tests currently are used, a rapid oral test would be easier to use in the home, according to the Globe.

Married Couples
The Western Ugandan study, along with a separate study conducted in Eastern Uganda, found that about 43% of HIV-positive people who were married had spouses who were HIV-negative, the Globe reports. Researchers said the studies suggest that more programs should be instituted to counsel married couples to abstain from sexual intercourse, use condoms 100% of the time or have "intimacy without intercourse," according to the Globe. Harvard University anthropologist and researcher Edward Green, who delivered the keynote speech on prevention, questioned whether condoms are the best prevention method for serodiscordant married couples. "[S]tudies show it's very difficult for married couples to use condoms," Green said, although he did not suggest an alternative method for preventing HIV transmission between spouses. Several people attending the conference held "angry discussions" about whether Green's comments would become U.S. policy and the implications for condom access, according to the Globe. However, Carolyn Ryan, PEPFAR senior technical adviser on prevention, said, "The point is consistent condom use is the most effective tool" for those couples. "Consistent condom use reduces risk by approximately tenfold," she added (Donnelly, Boston Globe, 5/31).

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