All Governments Must Overcome ‘Inertia’ in Implementation of Current HIV/AIDS Strategies, Opinion Piece Says

Countries should "change the way they view HIV and AIDS by rearranging priorities for spending," Arthur Ammann, president of Global Strategies for HIV Prevention, writes in a BMJ opinion piece. According to Ammann, public health agencies should supply the resources to test all blood donors; communities should change cultural practices that "contribute to high rates of sexual transmission"; all individuals should be tested for HIV to help "break down the barrier that HIV only affects 'them' and not 'me'"; and governments must overcome the "inertia that surrounds implementation of prevention strategies." In addition, proponents of abstinence-only sex education, who claim that condoms are not effective in preventing HIV transmission, and proponents of condom distribution programs, who say that abstinence is not an effective HIV prevention strategy, "are both wrong," Ammann says, adding that programs and messages that "truncate known public health measures are dishonest and cost human lives." He writes, "There is not enough time to wait for 'trickle down' or 'from the center out' approaches" to start working. Ammann concludes that governments, nongovernmental organizations, schools, religious groups, community leaders and individuals all must work together to engender change, adding, "[B]eing serious about [HIV/AIDS] prevention calls for change in behavior on everyone's part" (Ammann, BMJ, 6/21).

'Education and Debate'
The "Education and Debate" section of the June 21 issue of BMJ is dedicated to HIV/AIDS issues. The following is a summary of those articles:

• "Antiretroviral Treatment in Developing Countries: The Peril of Neglecting Private Providers": The improper use of antiretroviral drugs could lead to the development of drug-resistant HIV, "so it is important to take account of private providers and regulate their behavior," according to Ruairi Brugha of the London School of Hygiene and Tropical Medicine's Department of Public Health and Policy. Brugha says that the problem facing developing countries is that low-income people "are more likely to use informal [health care] providers such as drug shops and vendors [to receive antiretrovirals] as they lack other affordable options." Studies have shown that some patients who obtain their medicine from informal vendors have poor adherence rates, stop taking the medications on the advice of traditional healers or others, or receive incorrect doses, Brugha says. Brugha concludes, "The goal of an AIDS-free world is too important to risk failure through ideological disputes over public or private sector approaches at the local or global level" (Brugha, BMJ, 6/21).
  
• "Back to Basics in HIV Prevention: Focus on Exposure": Several countries are "failing" when it comes to HIV prevention programs because they are not "paying enough attention to who is becoming infected and how," according to Elizabeth Pisani of Family Health International and colleagues. After examining current HIV prevalence and incidence in five countries -- Cambodia, Indonesia, Honduras, Russia and Kenya -- each facing different epidemic levels, the researchers conclude that "in the short term," those in charge of HIV prevention programs should focus "where most new infections are occurring, while other partners such as religious and political leaders take the lead in changing the social and cultural factors that influence people's sexual and drug taking habits" (Pisani et al., BMJ, 6/21).
  
• "Public Policies and the Orphans of AIDS in Africa": Sub-Saharan Africa's HIV/AIDS epidemic "cannot be tackled without a concerted effort from international and national agencies" and a "combination of pragmatic approaches," according to Alok Bhargava, a University of Houston economics professor, and Betty Bigombe, a World Bank consultant. They say that it is "unrealistic" to assume that orphans of the disease can "escape from poverty without massive support" from agencies such as the World Bank and the United States Agency for International Development. Bhargava and Bigombe conclude, "In the absence of a cure for AIDS, international agencies have an important role in providing technical advice as well as funds for maintaining the current levels of economic activity in sub-Saharan African countries" (Bhargava/Bigombe, BMJ, 6/21).
  
• "Tackling India's HIV Epidemic: Lessons from Africa": India's foreseeable "major" HIV epidemic could be lessened by employing lessons learned from fighting the disease in sub-Saharan Africa, according to Malcolm Potts and Julia Walsh of the University of California-Berkeley. Based on literature reviews, economic analyses and personal experience, the authors state that Indian officials should focus on "cost-effective" preventive programs; amass "adequate" supplies of condoms and antibiotics; fund only projects that can be fully implemented; use traditional health practitioners in control programs; and confront lobbying for increased use of antiretrovirals (Potts/Walsh, BMJ, 6/21).