As World AIDS Day 2008 approaches, the conversation about how best to prevent the spread of HIV/AIDS continues.
“If we really want to advance the effectiveness of HIV prevention, we have to disabuse ourselves of the notion that the epidemic can be conquered by a single best intervention. Rather, we must focus on scaling up combination efforts and on building the evidence base for which mixes produce maximum effect in which settings.”
Those are the closing words of correspondence in The Lancet by Michael Merson and other international colleagues. The correspondence is part of an ongoing discussion sparked by an article in The Lancet’s August 9, 2008 HIV Prevention Series.
“Although we applaud David Wilson and Daniel Halperin’s endorsement of the UNAIDS call to “know your epidemic, know your response,” they seem to imply an unfortunate narrowing of HIV prevention to just one or two stand-alone interventions. The real world of HIV programming is not so simple,” say Merson and his colleagues.
They point out that male circumcision, for example, must be combined with other measures to avoid the misconception that unprotected sex is risk free for those who are circumcised. They also stress the importance of community ownership of interventions, and interventions that address both immediate risk settings as well as social norms and regulatory environments. “Our call to action to fully implement combination prevention is framed in terms of accepting its complexity: neither paralysed in the face of vast social inequities nor tempted by magic bullet solutions,” they say.
A PDF of the article is available here. The original article by Dr. Merson and his colleagues is available here.
