AEGiS-WSJ: AIDS Group Says More Focus Needs to Be Put on Prevention - Expanded Access to Drugs Could Lead People at Risk To Let Their Guards Down

Important note: Information in this article was accurate in 2004. The state of the art may have changed since the publication date.

AIDS Group Says More Focus Needs to Be Put on Prevention - Expanded Access to Drugs Could Lead People at Risk To Let Their Guards Down

Wall Street Journal - June 11, 2004
Marilyn Chase, Staff Reporter of The Wall Street Journal

A group spearheaded by the Bill and Melinda Gates Foundation is warning that the drive to expand access to AIDS drugs could backfire, fueling growth of HIV infections, if treatment isn't paired with efforts to prevent the spread of infections.

Amid the push to expand lifesaving drugs world-wide, prevention has gotten short shrift, warned Helene Gayle, who heads AIDS programs for the $26 billion foundation. The foundation this year launched a $200 million prevention program in India. No new Gates funds accompanied the release yesterday of a 20-page report by the Global HIV Prevention Working Group.

Separately, however, the Bush administration yesterday committed $15 million toward a global AIDS vaccine enterprise. The funding will be part of the federal government's fiscal 2005 budget, which includes $533 million for AIDS vaccine research. The $15 million pledge follows endorsement of a global vaccine effort by countries attending this week's G-8 summit.

The prevention report warns that expanded access to lifesaving drugs could lead to resumption of risky sex in poor countries, just as it has in rich countries. Abandoning caution has sparked a doubling of HIV diagnoses in the United Kingdom and outbreaks of syphilis and gonorrhea -- surrogate markers of AIDS risk -- in the U.S.

"Treatment [alone] ... isn't a solution to the epidemic," Dr. Gayle said, adding that a combination of treatment and prevention is necessary. Yet today, Dr. Gayle said, "only one in five people at risk have access to prevention."

World-wide, prevention expenditures fall below $2 billion. Dr. Gayle urged that spending on prevention be tripled to roughly $6 billion by 2005. If prevention funding isn't increased, she warned that all the world's drug programs will never keep pace with the spread of HIV.

Last year, five million new people contracted HIV, the human immunodeficiency virus, expanding to 40 million the number of people living with HIV/AIDS world-wide. Targets of the prevention appeal would include major funders of expanded drug access, such as the World Health Organization's "3 by 5" plan to give three million people AIDS drugs by 2005, and the U.S. President's Emergency Plan for AIDS Relief.

Because as many as 90% of people with HIV in many developing countries aren't aware of their infection, the report suggests a policy shift from HIV testing upon request, to testing on a routine basis unless people "opt out." Testing would still be voluntary. But instead of requiring people to ask for it, testing would be automatic unless refused. Advocates for women called the proposal worrisome.

"Opt-out testing is going to turn women world-wide into guinea pigs," said Joanne Csete, director of the HIV/AIDS Program at Human Rights Watch in New York City. Infected women in Africa and Asia face risks of violence and abandonment by their partners, she said.

Peter Piot, executive director of the United Nations Joint Program on AIDS, said that treatment is crucial but "if you do only treatment, you'll have more infections because the perception is the problem is fixed."

Despite evidence that people with HIV can become less contagious with treatment, studies modeling the course of the global epidemic show "the potential for a huge backfire," Dr. Gayle said. If drug programs inspire a rebound in risky behavior, the report says that "the benefits of [AIDS treatment] will be overwhelmed," fueling a bigger epidemic.

The Global HIV Prevention Group, a group of 50 health experts from 15 countries assembled by the Gates Foundation and the Henry J. Kaiser Family Foundation, called for testing, counseling and prevention sites to accompany all new drug programs.
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