Intensive HIV prevention efforts must be increased to address the continuing high number of new HIV cases in sub-Saharan Africa, according to a report scheduled to be released in June by the Global HIV Prevention Working Group, the New York Times reports. According to the working group, which was convened in 2002 by the Bill & Melinda Gates Foundation and the Kaiser Family Foundation, sub-Saharan Africa could face more than 36 million new HIV cases by 2015 if current trends continue. The group also said that clinics will see an ever-growing number of people in need of treatment and that millions of people will die from the disease.

According to the working group, the continuing high number of new HIV cases is because of a lack of intensive prevention efforts. Developing countries and donors have focused less on prevention programs during the past several years, even as the number of new HIV cases appears to be outpacing treatment efforts, according to the report. "Despite their promise, HIV prevention efforts have received short shrift in the global HIV response," the report says. The shift to treatment programs in part is because they produce "tangible, dramatic evidence of money well spent," the working group said, adding that an "averted infection is almost impossible" to show, even though prevention is more cost-effective in the long-term.

UNAIDS estimates that prevention programs worldwide reach fewer than one in five people at high risk of HIV. The group also says that in 2005, $3.2 billion was spent on prevention -- $2.5 billion less than what was needed for the efforts, the Times reports. According to the working group's estimates, an adequately funded and executed prevention campaign could reduce the number of HIV cases worldwide in 2015 by nearly two-thirds -- a "degree of success [that] would likely disable the epidemic."

Experts agree that one of most "glaring examples of flagging prevention" is the high rate of mother-to-child HIV transmission during childbirth or breast-feeding, the Times reports. Mother-to-child transmission is "relatively simple" to prevent by giving a single dose of the antiretroviral nevirapine to the mother and infant at birth. However, a "vast majority" of the 460,000 sub-Saharan children who contracted HIV last year contracted the virus from their mothers. Mother-to-child HIV prevention programs are growing, but they still reach only 11% of HIV-positive pregnant women, the Times reports. In addition, HIV-positive mothers who are aware of their status and have chosen to take nevirapine tend to ignore the risk of transmission during breast-feeding longer than six months after birth because of tradition or lack of food (LaFrainier, New York Times, 6/6).

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