Originally published on Advocate.com May 20 2008 12:00 AM ET
When AIDS erupted
more than two decades ago, health experts quickly
devised a strategy for stopping the disease's spread in the
developing world: Distribute free condoms and test for
dollars were poured into the campaign led by U.N. health
agencies and backed by governments around the world. But
what seemed like a natural way to fight the disease
had little impact in Africa, the region hardest hit by
Now, many experts
are calling for an entirely new approach to fighting
AIDS in Africa, saying there is little evidence current
things like condom promotion and HIV testing should work
anywhere,'' said Daniel Halperin, an AIDS expert at Harvard
University's School of Public Health.
''But if that
were true, countries like Botswana (with Africa's highest
prevalence of AIDS after Swaziland) should have wiped out
their HIV epidemic by now. These approaches just
haven't worked as well as we thought they would.''
In a recent
article published in the journal Science, Halperin
and other AIDS experts argued that health officials
are largely wasting money focusing on condoms, HIV
testing, and other strategies such as vaccine research
as the main tools for preventing AIDS in Africa.
Condom use in
Africa hasn't reached a high enough level to make a dent in
AIDS transmission, and there is scant evidence to show that
people change their sexual behavior even when they
know their HIV status, according to studies.
Africa nearly 21 million people were infected in 2001,
according to the U.N. Last year, that figure was estimated
to be 22.5 million.
And despite years
of research into finding an AIDS vaccine, the most
promising candidates have failed.
Halperin and his
coauthors said health officials should radically boost
funding for male circumcision, which can reduce HIV
transmission by up to 60%, and for programs to educate
people to reduce their number of sexual partners.
''Almost 99% of
the AIDS prevention money is going to things that don't
seem to work very well in Africa, and almost none of it is
going to things that would have a major impact,''
officials rejected the need for change and said there is
some evidence in Asia that condom distribution
programs reduce HIV transmission.
They also said
they have been working on guidelines to introduce mass
male circumcision, but that such a strategy will take years
''It's not right
to say that our approaches have not worked,'' said Paul
de Lay, an AIDS expert at UNAIDS. ''We are seeing an impact
in the epidemic's decline worldwide linked to our
Last year, the
U.N. revised its global figures for the number of people
with HIV or AIDS from nearly 40 million to 33 million. But
that drop was mostly due to new ways of estimating the
number of people with HIV.
suggest the decline is due more to a natural leveling off of
the epidemic, with infected people dying, rather than to the
success of the U.N.'s anti-AIDS strategies.
year, the United States, the biggest funder of AIDS efforts
in Africa, agreed to triple its spending to combat AIDS on
the continent, pledging $10 billion annually over the
next five years. The U.N. estimates it will need more
than $3 billion by 2010 for HIV prevention efforts in
Africa and $15 billion worldwide.
But some experts
argue that -- more than two decades into the fight
against AIDS -- the epidemic would have tapered off more by
now in the developing world if current methods were
beginning, people said that this was a public health
emergency and that we should just get in there and do
something,'' said David Mabey, an AIDS expert at
London's School of Hygiene and Tropical Medicine.
''But that was
short-sighted. Some things are clearly not working in some