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'Prevention, Cultural Changes Must Lead AIDS Battle'

Treating the millions of sufferers of HIV and AIDS may be the subject of science and medicine, but preventing the spread of this deadly disease// cannot be done without changing the cultural norms that drive it.

That was the message during a "stock-taking" discussion by the World Bank and US-based Family Health International (FHI) leaders that sought to emphasise the benefits and cost effectiveness of prevention techniques such as contraception. "We are not giving prevention a chance," said Debrework Zewdie, director of the World Bank's global HIV/AIDS programme, at a news conference in Washington Thursday. Zewdie characterised the choice as "pay now for prevention or pay more later for treatment".

An average of between four and five million people worldwide are newly infected with HIV every year, and the epidemic now afflicts 39.5 million people, recent statistics showed. Anti-retroviral drugs have allowed many AIDS patients to live longer and fuller lives than ever before, yet for every patient treated with antiretroviral annually, almost three more are contracting the disease.

"Do the math - we are losing the HIV war," said Ward Cates, president of research at FHI, a US-based non-profit organisation that focuses on public health in the developing world. There is no one solution to the AIDS epidemic, but Cates argues that greater focus should be placed on sexual health and the benefits of preventing unwanted pregnancies in combating the disease.

Each day, 1,500 children worldwide become infected with HIV, the vast majority of them newborns. In Sub-Saharan Africa, which accounts for two-thirds of all AIDS sufferers, FHI estimates that contraception is already preventing about 170,000 unwanted pregnancies annually that would have resulted in HIV-positive infants. The group says that number could be doubled if all women who did not want to become pregnant got the help and tools they needed.
On a scale of increasing importance from one to 10, Cates rated the importance of science in the struggle at about three. He put a seven next to the impact of cultural norms, political will, community standards, and what he calls "the general determinants of health". But changing cultural norms is difficult, because each society has different norms that affect their view of prevention techniques - whether it's using condoms or reducing the number of sexual partners.

"What we are trying to do is meet them where they are in terms of their personal norms or their societal norms," said Cates. "We need multiple, reinforcing messages that slowly but surely will...add up to measurable population changes." It's a slow process, but so is progress on medical solutions such as AIDS vaccines. Scientists working in that field don't expect an effective vaccine for another 10 years. The UN has set a goal of 2015 for halting the spread of AIDS and reversing its course. The biggest challenge will be ensuring that "complacency" doesn't set in among governments that have begun to take action, the World Bank's Zewdie said.


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