HIV, with Dr Watiti

May 02, 2011

REDUCING new HIV infections is becoming a real challenge, considering the fact that we now understand the disease better than we did earlier.

Dear Doctor,
I am worried by the increasing numbers of new people being infected with HIV and wonder why we do not go back to stressing the ABC messages of the 1980s and 1990s. The messages helped us bring down the prevalence from 30% at its peak to the present 6-7%, where we have stagnated for a long time.
John

Dear John,
REDUCING new HIV infections is becoming a real challenge, considering the fact that we now understand the disease better than we did earlier.

It should be understood, however, that the ABC messages may not have the same effect they had then because of the normalisation of the HIV epidemic since it no longer makes people fear as much as they did then, thus leading to behaviour change.

We should of course continue encouraging abstinence for young people and those who are not married, mutual faithfulness for the marrieds or unstable relationships after testing, plus correct and consistent condom use whenever in doubt.

However, the understanding now is that we need to use combination prevention strategies much the same way we use a combination of three or more types of ARVs when treating HIV.

People involved in HIV/AIDS care and prevention are encouraged to know the nature of the epidemic they are dealing with because it is clear it is not homogeneous, and varies from community to community, driven by different factors, both behavioural and structural. These drivers of the epidemic must be addressed if it is to be tackled effectively.

That is why there are now new interventions like safe male circumcision, use of microbicide gels by women and even treatment with ARVs in order to lower the viral load of people already infected, thus reducing their capacity to transmit HIV to others.

None of these, including ABC is “a silver bullet” that can be used in isolation. We must appreciate the importance of all available proven interventions as we work towards “zero new infections, zero AIDS-related deaths and zero stigma and discrimination” towards PLHIV since they are important partners in this fight.

We must remember that for every new infection that takes place, both an HIV-positive and HIV-negative person are involved.

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