Rethinking HIV-Condom Strategy In Africa

Campaigns Promoting Safer Sex Ineffective In Africa, Experts Say

(AP)  When AIDS erupted more than two decades ago, health experts quickly devised a strategy for stopping the disease's spread in the developing world: Distribute free condoms and test for HIV.

Millions of dollars were poured into the campaign led by U.N. health agencies and backed by governments around the world. But what seemed like a natural way to fight the disease had little impact in Africa, the region hardest hit by the epidemic.

Now, many experts are calling for an entirely new approach to fighting AIDS in Africa - saying there is little evidence current strategies work.

"Intuitively, things like condom promotion and HIV testing should work anywhere," said Daniel Halperin, an AIDS expert at Harvard University's School of Public Health.

"But if that were true, countries like Botswana (with Africa's highest prevalence of AIDS after Swaziland) should have wiped out their HIV epidemic by now. These approaches just haven't worked as well as we thought they would."

In a recent article published in the journal Science, Halperin and other AIDS experts argued that health officials are largely wasting money focusing on condoms, HIV testing and other strategies such as vaccine research as the main tools for preventing AIDS in Africa.

Condom use in Africa hasn't reached a high enough level to make a dent on AIDS transmission, and there is scant evidence to show that people change their sexual behavior even when they know their HIV status, according to studies.

In sub-Saharan Africa nearly 21 million people were infected in 2001, according to the UN. Last year, that figure was estimated to be 22.5 million.

And despite years of research into finding an AIDS vaccine, the most promising candidates have failed.

Halperin and his co-authors said health officials should radically boost funding for male circumcision, which can reduce HIV transmission by up to 60 percent, and for programs to educate people to reduce their number of sexual partners.

"Almost 99 percent of the AIDS prevention money is going to things that don't seem to work very well in Africa and almost none of it is going to things that would have a major impact," Halperin said.

U.N. health officials rejected the need for change and said there is some evidence in Asia that condom distribution programs reduce HIV transmission.

They also said they have been working on guidelines to introduce mass male circumcision, but that such a strategy will take years to implement.

"It's not right to say that our approaches have not worked," said Paul de Lay, an AIDS expert at UNAIDS. "We are seeing an impact in the epidemic's decline worldwide linked to our interventions."

Last year, the UN revised its global figures for the number of people with HIV or AIDS from nearly 40 million to 33 million. But that drop was mostly due to new ways of estimating the numbers of people with HIV.

Some experts suggest the decline is due more to a natural leveling off of the epidemic, with infected people dying, rather than to the success of the UN's anti-AIDS strategies.

Earlier this year, the United States, the biggest funder of AIDS efforts in Africa, agreed to triple its spending on combating AIDS on the continent, pledging $10 billion annually over the next five years. The U.N. estimates it will need more than $3 billion by 2010 for HIV prevention efforts in Africa and $15 billion worldwide.

But some experts argue that - more than two decades into the fight against AIDS - the epidemic would have tapered off more by now in the developing world if current methods were effective.

"At the beginning, people said that this was a public health emergency and that we should just get in there and do something," said David Mabey, an AIDS expert at London's School of Hygiene and Tropical Medicine.

"But that was short-sighted. Some things are clearly not working in some countries."

[wbwilhite]

Eggs are bad for you. No wait! Eggs are good for you. Circumcision is good for you. No wait! Ahhh... too late.

[taylor2124]

Might as well try to train monkeys to play the piano. Handing out condoms to Africans..what a joke.

[flagship-usa]

purocabron1 at 05:03 PM : yeah, interesting stuff.

Men that are circumcised are at a higher risk.

Are body(s) is apply suited in fighting off infections. The foreskin makes sense. There is a enzyme that is secreted that will kill germs and organisms that are foreign, including the HIV virus. And I''m sure the act of urinating will also flush out and keep clean this area. Urine can be above or below a ph of 7.0 (-acidic or +alkaline) 7 represents neutrality. Urine is sterile. It could be considered a antiseptic.

Anyway: nice gym (real men are not circumcised)

[purocabron1]

flagShip-usa, I also found this doing a google search,

Caucasians have the highest circumcision rate, followed by African Americans and Hispanics. Geographically, the highest rates are found in the Midwest, followed by the Northeast, the South, and the West.

[purocabron1]

flagShip-usa, that is some interesting information and I will admit it gets me thinking toward your side of the argument. However, your sources back up my assumptions, as stated in your first source.... "For example, circumcision incidence in the U.S. is lower among poor and Hispanic people.6" That''s kind of where my gut was leading me. However, as I stated, your sources did make some very valid points

[flagship-usa]

purocabron1 at 11:24 AM : You can google the rest.

http://www.cirp.org/library/disease/HIV/
http://hivskeptic.wordpress.com/2008/02/03/rwanda-circumcise-all-men-even-if-it-means-more-hiv-infection/

[dogsoul]

Sooooooo - what''s the conclusion here???? I mean, Africa is certainly not the ONLY ''developing'' nation - yet it seems to be the standout when it comes to these programs NOT doing much of anything....

Hmmmmm.... what in the world could be unique about Africa that might cause this sort of thing?

Perhaps it''s the lions?

Not sure... but according to my pastor, this is all part of the White Gov''t of America''s plan to rid the world of black people....

[jboxton]

You can''t go into the jungle and give condoms to a bunch of natives/savages and expect that to work. They still put bones through their noses. How can they be expected to understand the concept of condoms?

[purocabron1]

flagShip-usa, could you please let us know where you get your information from. I don''t know about circumcision rates for African Americans, but saying that latinos have a higher rate of circumcision really confounds me. I grew up in a community that was 70% latino and I don''t ever remember seeing a latino male who was circumcised (in the showers after gym). I would venture a guess that less than 10% of latinos are circumcised, although it''s just a guess.

[ccdsswrkr08]

"Condom use in Africa hasn''t reached a high enough level to make a dent on AIDS transmission, and there is scant evidence to show that people change their sexual behavior even when they know their HIV status, according to studies."

When did it go from survival of the fittest, to survival of the idiots?