How to grossly reduce HIV/AIDS

OPINION | HIV/AIDS

By Dr. Majwala Meaud Major

Before we talk and talk about elimination of HIV/AIDS, let us be focused on prevention measure which are affordable and practically feasible. Although fundamental political, financial and implementation challenges remain, but we should not stop now. It is time to move forward to ensure that all children start their lives free from HIV, that young people and adults grow up and stay free from HIV and that treatment becomes more accessible so that everyone stays AIDS-free.  Henceforth, we all share the challenge to ensure that those who are identified to be HIV positive are initiated on treatment.

There's a lot to be optimistic about in the global fight against HIV and AIDS. By the end of 2015, 13.7 million people were taking life-saving anti-retroviral therapies that suppress the virus and help people lead long, healthy lives-12.8 million of which were from low- and middle- income countries, according to the World Health Organization. Groundbreaking research is uncovering better ways to keep AIDS at bay and prevent HIV infection and transmission. There's even some promising evidence that HIV's ability to cause AIDS is weakening over time, as the result of genetic mutations. To celebrate these advances, as well as World AIDS Day, it's important to note that there's still a long way to go in making sure everyone has access to the treatment they need to lead a healthy life. HIV/AIDS still affects approximately 35 million people worldwide, and not all of them have adequate access to anti-retroviral drugs or even primary health care. We should all aim at putting an AIDS-free generation on the horizon.

But for those living in the hardest-hit parts of Africa, there are risks in the policy shifts underway in Washington and other western capitals. The rising enthusiasm for providing more medicines threatens to come at the expense of promising initiatives for preventing HIV infections in the first place-initiatives that could save many lives, with less money. Ambitious treatment efforts and smart prevention programs are, of course, not inherently at odds. But especially in an era of fiscal constraint, these two goals could come into conflict. The result, wasteful in dollars spent and lives diminished, would represent only the latest misjudgment by powerful donor nations such as the United States, which still struggle to understand the root causes of an epidemic that has spread most widely in weaker, poorer nations.

As we remember, President George W. Bush's $15 billion commitment to fighting the epidemic overseas was a turning point in the drive to get AIDS medicine to nations that couldn't afford it. President Obama also oversaw an expansion of funding and a focus on providing drugs and other biomedical tools for fighting the epidemic. All these efforts are doing wonders in Africa up to today. Of course, AIDS drugs do not cure the disease; recent estimates suggest that even well-treated patients may have their life spans shortened by about a decade. Still, these treatment initiatives allow many people with HIV to live much longer, better lives.

These breakthroughs have raised hopes that further widening access to AIDS drugs is the key to reversing the epidemic's march.  With all such endeavors in practice, can we say that it is time to consider shifting funding from AIDS programs that seek to alter sexual behavior toward those that expand access to drugs? Western policymakers call this approach "treatment as prevention," while some activists go further, saying "treatment is prevention." But the relationship between treating AIDS and preventing HIV infection is hardly so simple, and the enthusiasm inspired by "treatment as prevention" already is sapping resources and energy away from some other initiatives for fighting the disease.

It's also not clear that, even with massive new investments, the drugs can reach enough people to cause meaningful declines in HIV's spread. Even in the United States, with a medical system far superior to any in Africa, most people with HIV are not in treatment or are not taking drugs consistently enough to suppress the virus to the point where the risk of transmission is significantly reduced.

When debating how to prevent HIV, liberals like to talk about condoms, while conservatives often talk about abstinence. Yet the track record for both ideas has been disappointing. Reported condom usage rates soared in many parts of Africa years ago, but HIV infection has remained high, probably because they are not consistently used in ongoing sexual relationships. Abstinence programs have prompted some teens to delay sexual activity, but only briefly, typically pushing the risk into the future by a year or less.

The writer is the president of Sustainable World Initiative-East Africa