Researchers say HIV prevention methods in Africa are ineffective
By Emily Grospe

Source: Daily Californian, UC-Berkeley
5-27-08

A new policy analysis paper by campus researchers says that current HIV prevention approaches show little evidence of large-scale impact in areas of high HIV prevalence in Africa.

Researchers from UC Berkeley, Harvard University School of Public Health and UC San Francisco claim that the most established strategies-such as condom promotion, HIV testing and treatment of other sexually transmitted infections-receive the largest allocation of donor investments, yet show relatively weak evidence of effectiveness.

According to the paper, condom promotion is still not at a sufficient level to slow infections, HIV testing shows no consistent reduction in the risk of those tested HIV-negative, and treatment of sexually transmitted infection shows little effect on HIV transmission.

The authors advocate two methods of HIV prevention, which evidence suggests are more effective but receive little priority-male circumcision and the reduction of multiple sexual partners.

Circumcision reduces HIV risk by at least 60 percent and its effects last a lifetime, said Malcolm Potts, co-lead author and Bixby professor of population and family planning at UC Berkeley's School of Public Health. Because the foreskin contains specialized Langerhans' cells, which HIV attaches onto directly, removing it decreases chances of HIV transfer.

"Once foreskin is removed, it's not something that jumps back on in moments of sexual excitement," Potts said. "It's a lifelong effect and that's why it's very powerful."

Ann Swidler, sociology professor at UC Berkeley and contributor to the paper, said that although condom use is extremely effective in reducing transmission risk, some people still resist condom use.

"I think the main reason is that condoms are just defined as something you would use with people who are dangerous, when you're having risky sex," said Swidler. "Not using a condom is a way of showing emotional involvement or commitment."

Daniel Halperin, co-lead author and senior research scientist at Harvard University's School of Public Health, said the effectiveness of reduced sexual partners is evident when studying patterns in a number of countries in Africa.

"In virtually every place HIV has gone down, there has been a reduction in the proportion of people reporting multiple partners."

Potts said the researchers are hoping the findings will encourage people to reduce concurrent sexual partners.

"People tend to make a romantic relationship, they have sex with somebody, the relationship may fall apart and they make a new relationship. It's what we call serial monogamy," Potts said.

Potts said that in the field of public health, it is often difficult to admit a mistake once an idea has gained momentum.

"If you're working in public health, you have to make an honest diagnosis," he said. "Even if it's disappointing, you have to admit if something is a failure."