Curing AIDS is All Prevention

The plight of the HIV/AIDS epidemic was poignantly summarized by UNAIDS in its recent update: forty million people infected, 3 million annual deaths, and 5 million new infections this year. Is the war on AIDS being lost? It looks that way.While the world has mobilized funds and focused on treatment, HIV/AIDS has spread rapidly. Treatment does nothing to check transmission nor does it cure its victims. Richard Holbrooke’s editorial in the Washington Post on November 29th raises the need for testing, and that is part of the solution. But testing can’t do it alone.Without effective and broad prevention efforts the pandemic will continue unabated and the war will be lost. UNAIDS devotes an extensive chapter (pdf) to prevention in its recent report. The statistics they cite are frightening: 90 percent of those living with AIDS have not been tested and therefore don’t know they are HIV positive, and only 20 percent of those at risk are reached by prevention. Those findings simply reinforce the gap in prevention.Prerequisites for testing include information, outreach, and a focus on high risk groups who engage in risky behaviors, many of whom live on the margins of society, issues that UNAIDS mentions in its report. But testing without making condoms widely available is like telling bicyclists that they are at risk of fatal head injury but neither informing them about helmets nor ensuring their ready availability. What is different about bicyclists, however, is that their lack of helmet use doesn’t endanger others’ lives.The HIV/AIDS success stories in the developing world -- Brazil, Thailand and Uganda -- emphasize prevention: public awareness raising, reaching high risk groups and widespread condom availability. If we as a global community are serious about this war and saving lives, then there is no place for excuses. Modesty can’t be an excuse for diluting explicit information for the public; privacy can’t be a rationale for not promoting counseling and testing; and religious fervor in the developed world can’t limit widespread condom availability. People’s lives are at stake.While treatment provides a critical but short term band aide, prevention gives us the only way to curb the pandemic that increasingly appears out of control.