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Expand HIV/AIDS Prevention Programs, Experts Stress

The battle against HIV/AIDS is becoming grimmer by the day. As many as 60 million more people around the world could be infected with HIV/AIDS by 2015 if the current prevention programmes are not expanded, experts have warned.

"We should be winning in HIV prevention," Jennifer Kates, vice president and director of HIV policy at the Kaiser Family Foundation, said Friday.

But the reality is that HIV prevention groups have the tools, but not the money, to make enough of a difference, according to a new report from the Global HIV Prevention Working Group.

The working group, made up of more than 50 public health experts, clinicians, researchers and people living with HIV, previewed the report at an international conference in Rwanda two weeks ago and released it this week.

Kates said organizations fighting HIV infection now spend about $10 billion (7.4 billion) on treatment, prevention and care in developing countries around the world. They would need $22 billion (16.3 billion) by 2010 to start to decrease infection rates, and half of the money would need to be used for prevention.

With enough money to expand HIV prevention around the world, the working group estimated new HIV infections could be cut in half to 30 million by 2015.

The report estimated that current prevention work is reaching fewer than one in five people who could benefit. For example, in low- and middle-income countries in 2005, just 11 percent of HIV-infected pregnant women had access to the inexpensive anti-retroviral drugs that greatly reduce the risk of mother-to-child HIV transmissions.

In the African countries most seriously affected by AIDS, only 12 percent of men and 10 percent of women had been tested for the HIV virus and knew their status in 2005, according to UNAIDS and the World Health Organization (WHO).

"Over the past few years, there have been major increases in funding for AIDS, but we are still wel l short of what is needed," said Dr. Nicholas Hellmann, interim director of the HIV and TB programs for the Bill & Melinda Gates Foundation and a member of the working group.

Money for HIV programs in low- and middle-income countries increased by a factor of six between 2001 and 2006, but efforts to reduce HIV infection are faltering, the report said. In 2006, for every person who started anti-retroviral treatment, another six were infected with HIV.

"We need to make the same gains in HIV prevention that we are making in HIV treatment," said Helene Gayle, president and CEO of CARE USA and co-chair of the Working Group. "We have a critical window of opportunity over the next 10 years to dramatically slow the rate of new infections, and ultimately reverse the epidemic."

"It's widely assumed that HIV continues to spread because prevention isn't effective, and that's simply not true. The problem is that effective prevention isn't reaching the people who need it," said David Serwadda, director of the Institute of Public Health at Makerere University in Uganda, and co-chair of the Working Group.

The report, titled Bringing HIV Prevention to Scale: An Urgent Global Priority, finds that scientifically proven prevention programs - such as those to reduce the risk of mother-to-child HIV transmission - are not being implemented on a sufficient scale, meaning they do not reach enough people, with enough intensity, to curb the epidemic. The report recommends that global spending on AIDS double over the next three years, and calls on governments and donors to ensure that resources are spent on proven prevention strategies targeted to people at highest risk.

With expanded prevention, the annual number of new infections would drop to 2 million per year by 2015 - a level that may cause the epidemic to move into long-term decline.

Adding male circumcision to prevention programs would account for 8% of the drop in infections by 2015, a significant impact for a single intervention. This underscores the potential power of male circumcision as a prevention tool, provided it is used in combination with other proven prevention strategies - including AIDS education, condoms, HIV testing, and prevention of mother-to-child transmission.

"While adult male circumcision can be an important addition to prevention programs, no single prevention strategy is 100% effective," said Salim Abdool Karim, pro-vice chancellor for research at the University of KwaZulu-Natal in South Africa, and a member of the Working Group. "We need to use all proven prevention strategies in combination."


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