AIDS expert: drugs and prevention vital

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Combining prevention with treatment is the only way to battle the global AIDS epidemic and to ensure that everyone who needs life-saving drugs gets them, a leading AIDS expert said on Monday.

Dr Helene Gayle of the Bill & Melinda Gates Foundation said the message of access, which has been a prime focus at the 15th International AIDS Conference, not only refers to treatment but to prevention, care and support.

"If we expect to keep treatment goals we can’t even begin to do that without continuing to reduce the number of new infections,” she told Reuters.

The World Health Organization has a program to provide antiretroviral drugs to three million people by the end of 2005.

“But we have five million new infections occurring every year so in order to make treatment doable, and definitely to keep it sustainable, we need to make sure we have as few people as possible needing treatment in the future.”

AIDS experts estimate that comprehensive prevention could avert 29 million of the 45 million new infections projected to occur this decade.

But only about one in five people at high risk of being infected with HIV/AIDS has access to prevention programs or services.

“We have barely scratched the surface,” said Gayle, who heads AIDS programs at the philanthropic organization founded by Microsoft’s chairman.

DOING IT BETTER ON BOTH FRONTS

Gayle believes the drive to scale up access to drugs provides an opportunity to twin it with prevention because the two are mutually reinforcing.

“Treatment can foster and facilitate greater prevention efforts. With more people having access to antiretrovirals you decrease the stigma, people are more willing to get tested and you have people entering the health system, which also gives you an opportunity for prevention.”

Gayle also warned that focusing on access to treatment without prevention could result in complacency, an increase in risky sexual behavior and a rise in new infections.

With women accounting for nearly 50 percent of people living with HIV/AIDS worldwide and half of new infections in young people, she stressed the importance of targeting both groups.

“It is a big issue. The intersection of youth and women is where a lot of our focus has to be, particularly young women in Africa who are bearing the brunt of this epidemic.”

But Gayle refused to be drawn into a debate at the meeting about whether abstinence or using condoms is more effective in preventing new HIV infections.

“We know that delaying sexual debut, even by a year, has a huge impact on reducing HIV infection in young people, particularly young women—the abstinence approach,” she said.

“On the other hand all the evidence suggests condoms have a huge role if used consistently and correctly in reducing the spread of HIV and if people who are uninfected are mutually monogamous we also know that works.”

There is no one approach because it depends on circumstances, what’s best for a given population the country’s population, she said.

“The debate is distracting because it is often argued in the absence of evidence. We need to be as evidence-based as possible and to look at the studies and see what makes the biggest difference in saving people’s lives.”

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