HIV/AIDS: The Prioritization of Prevention
SCOTT C. RATZAN
Earlier this year, two major international meetings reminded
us of the scourge of the human immunodeficiency virus (HIV)/acquired
immunodeficiency syndrome (AIDS). Since HIV/AIDS was first recognized
in 1981, this emerging disease has spread relentlessly throughout the
world to more than 40 million HIV-positive people, 95 of whom live in
developing countries. It now threatens to surpass in total fatalities
both the fourteenth-century ‘‘black death’’ and
the 1918–1919 influenza pandemic, which killed tens of millions
of people.
Now as HIV/AIDS is in its third decade the 2004 World
Health Organization (WHO) report Changing History calls for a comprehensive
HIV/AIDS strategy that links preven-tion, treatment, care, and long-term
support. Similarly, the XV International AIDS Con-ference in Bangkok
also endeavored to link community and science to galvanize the world’s
response to HIV/AIDS through increased commitment, leadership, and accountability.
In 2003 alone, 5 million new infections occurred—14,000
each day—with an estimated 3 million people with HIV/AIDS dying,
500,000 of whom were children. The growing numbers do not adequately
represent the devastation to individuals, families, communities, and
societies coping with HIV/AIDS. Further, they do not demonstrate the
devastating impact on economies and political stability.
The moderate success claimed thus far has largely been
biomedical. Two decades of basic research into the mechanisms by which
the virus propagates itself and evades and destroys the immune system
have characterized HIV/AIDS from probable death to a chronic disease.
With more than 20 antiretroviral drugs available, the level of virus
in an infected person can be reduced so that he or she can maintain
health for many years and also prevent mother-to-infant transmission
of HIV. Yet, in 2003 only about 400,000 of the 6 million people requiring
treatment actually received it.
Clearly, while the treatment opportunities are remote
for many, the WHO created a ‘‘3-by-5 initiative’’
with the goal to provide access to antiretroviral treatment (ART) for
those in developing countries who need it. The WHO and its partners
are working with full commitment to achieve the 3-by-5 target—providing
access of ART to 3 million people living with HIV/AIDS in developing
countries by the end of 2005.
Even with the WHO response, according to the Global HIV
Prevention Working Group, an international panel of nearly 50 experts
in HIV prevention, a major shift in HIV prevention tactics will be needed
to avoid a rise in HIV transmission and accel-eration of the epidemic.
Underfinancing of prevention activities is severely limiting the group’s
impact, they report. Since 2002, prevention often is characterized by
an approach called ‘‘A.B.C.,’’ which stands for
abstain, be faithful, use condoms.
The Bush administration has pledged $15 billion as part
of the President’s Emergency Plan for AIDS Relief. The administration
plan has earmarked one-third of the nation’s international AIDS
prevention funds to be used for abstinence programs starting in 2006.
Critics suggest that such programs alone are insufficient.
In fact, a New York Times editorial states the administration is using
pseudoscience to justify its decisions, as the administration and Congress
have removed information about condom use and references to the value
of sex education and condom promotion from the websites of the U.S.
Centers for Disease Control and Prevention and the U.S. Agency for International
Development.
The cost of failing to integrate prevention with treatment
services is significant as the number of new infections continues to
grow, with a resulting need continually to expand HIV treatment services.
Further, experts warn that unless programs grow dramatically in scale
in the next few years, any integration of prevention and treatment that
does take place will have a marginal impact on the onward march of HIV
into new populations.
Against this backdrop, the largest scientific and health
bodies attempt to advance public health, but the communication challenge
is as great today as in the early days when the disease was thought
to be spread only amongst homosexuals and certain risk groups.
Recently, a historic meeting of leadership of the World
Health Professions Alliance (WHPA) in Geneva, representing more than
20 million health professionals worldwide, unanimously passed a resolution
urging governments to recognize the scale of the tragedy facing the
world and to immediately commit the necessary funds to fight the pandemic.
The evidence-based principles are universal in intent:
- the current HIV/AIDS pandemic presents an extraordinary health, human
rights, and humanitarian crisis;
- especially women and children are affected;
- focused prevention programs can significantly reduce new infections;
- treatment options allow HIV positive persons to lead a quality life;
- without the appropriate prevention and treatment this crisis will
worsen to a level where some countries’ populations may be decimated
and their futures destroyed; and
- countries at the heart of the HIV/AIDS pandemic, provided they are
supported with the necessary financial and human resources, can rise
to the challenge.
The leaders of the medical, nursing, and pharmacy professions
called on all national governments, intergovernmental agencies, and
health professionals to recognize the scale of the tragedy, to stop
procrastinating, and to commit, immediately, the necessary funds and
resources against HIV/AIDS.
The WHPA resolution presents a challenge that those in
communication can advance. Perhaps many of us as individual readers
of this journal can similarly articulate the resolution in our professional
organizations to help galvanize the support necessary of leadership
to act as strong advocates and social leaders in the fight against HIV/AIDS.
_____
Scott C. Ratzan MD, MPA is Editor-in-Chief of the Journal of Health
Communication: International Perspectives. His publications include
AIDS: Effective Health Communication for the 90s.
