Preventing sexual HIV transmission can be accomplished by: interventions to promote the adoption of safer sexual behaviours (abstinence, being faithful to one uninfected partner and condom use), voluntary counselling and testing, and timely diagnosis and treatment of other sexually transmitted infections (STIs) among those who are at risk of acquiring or transmitting HIV. Thus countries have been urged to mount effective interventions for preventing sexual, parenteral and perinatal HIV transmission and address local challenges faced in implementing prevention strategies.
But since HIV/AIDS is fuelled by a combination of poverty, behaviour and biology, prevention of new infections and care for the infected are key elements of today’s massive fight against HIV. Strategies for HIV/AIDS prevention include: behaviour change interventions, voluntary counselling and testing, STI diagnosis and treatment, antiretroviral therapy especially to interrupt mother-to-child transmission, microbicides, improving the safety of blood transfusion general healthcare settings such as operating theatres.
There is also considerable interest in the potential link between male circumcision and a lower risk of HIV acquisition. But more research is needed to confirm the reproducibility of the findings of this trial and whether or not the results have more general application.
ARVs could prevent a substantial number of HIV infections and significantly reduce HIV prevalence but would increase the transmission and prevalence of drug-resistant strains of HIV. Many authors have stated that increases in risky behaviour would mask antiretroviral-induced decreases in HIV transmission.
UNAIDS recommends a ‘combination’ approach of strategies including interventions targeted to those at high risk and broad campaigns for general awareness. Various prevention strategies including VCT, condom promotion among female sex workers and their clients, enhanced STI treatment programs, elimination of stigma so as to encourage VCT and treatment, HIV education in schools, and mobilization of senior religious leaders to talk about HIV and AIDS are some of the strategies that work.
The Global HIV Prevention Working Group in 2002 recommended that efforts to fight stigma, reduce poverty and empower women contribute to successful outcomes in preventing HIV infection.
Another vital ingredient of prevention success is strong leadership at the highest levels of government. Strong leadership sets the direction for a positive national response and initiates the development of sound policies to guide and sustain that response. Often cited in this regard is the example of President Yoweri Museveni of Uganda, who called on Ugandans at all levels to fight HIV and AIDS as “a patriotic duty”. His openness on the subject of HIV is credited with encouraging candid and sustained media coverage, further supporting a multi-sectorial response that has contributed to a large decline in the prevalence of HIV among youth.
Another approach is to change traditional beliefs and practices that fuel the epidemic. Some HIV/AIDS-infected individuals in Namibia do have sex with minors in the mistaken belief that they would be cured of their HIV infection. Home affairs deputy minister warned that all such healers would be prosecuted. This has led to an increase in the number of rapes of minors.
There are also international research efforts to develop HIV/AIDS vaccines and microbicides. An AIDS vaccine could be effective in either of two ways. A “preventive” vaccine would stop HIV infection occurring altogether, whereas a “therapeutic” vaccine would not stop infection, but would prevent HIV causing disease, and might also help prevent onward transmission. At the start of 2006, twenty-seven candidate preventive vaccines and fifteen possible microbicides were undergoing human trials around the world, and many more products were still at the development stage.
A microbicide could work in at least four different ways:
l Kill or inactivate HIV
l Stop the virus entering human cells
l Enhance the body’s normal defence mechanisms against HIV
l Inhibit HIV replication
It is possible that a microbicide could work in much the same way as a vaccine, so research in one area could benefit the other. Alternatively, a microbicide could work in a similar way to today’s antiretroviral drugs, or it could act like a detergent.
Since a treatment cure and vaccine for HIV/AIDS are still a pipedream, the most effective weapon is education and prevention.
l Kazhila Chinsembu is a lecturer in Molecular Biology at the University of Namibia. Email: firstname.lastname@example.org