Thursday, July 31, 2008

No Easy Answers: Debunking the False Dichotomies of the Global AIDS Response

by Mitchell Warren
[via Caucus for Evidence-Based Prevention Newsletter Issue 9]

To pit proven prevention against treatment or against research is a false and dangerous dichotomy.

The history of the global response to the AIDS pandemic is littered with false hopes, expectations and promises. More recently, and perhaps even worse, we now face false dichotomies as well: prevention or treatment; vaccines or microbicides; vertical AIDS funding or health systems strengthening; abstinence and be faithful programs or condom use (A and B or C).

But these aren’t mutually exclusive or even real choices, and debating them only prevents us from moving forward. There are over four million new infections every year. For every person who starts antiretroviral medications, another three are newly-diagnosed with HIV.

These are mind-numbing, tragic figures. And they serve as a constant reminder that there is only one viable answer to the question, Which of the many strategies before us do we pursue?

The answer is clear: We undertake them all even more aggressively.

We must not only continue but expand proven prevention strategies including male and female condoms, clean needles, prevention of mother-to-child transmission, risk-reduction counseling, and culturally appropriate male circumcision.

We must also do more to bring comprehensive care, treatment and support to people already living with HIV worldwide. Global targets have been set and missed and are in danger of being missed again.

In addition, we must continue to search for expanded treatment options and new biomedical HIV prevention strategies, including vaccines, microbicides and oral pre-exposure prophylaxis.

To pit proven prevention against treatment or against research is a false and dangerous dichotomy. The range of prevention and treatment options that we have at our disposal today is not reaching every person at risk. But even if it did, it is not enough. Women and men, adolescents, boys and girls and infants all still need more choices.

We must do everything possible to provide every person at risk with the options available to protect him or herself from HIV, and we must also recognize that the best approach to prevention is one that provides the most options. Since there is no magic bullet--be it a condom or a clean needle today or a microbicide or vaccine tomorrow--there is only the ethical and moral imperative to develop a multi-faceted response that is a match for the multiple drivers of the epidemic itself.

We will not treat our way out of this epidemic, we will not prevent our way out, and we won’t research our way out either. We will end this epidemic only when we harness all three components as the three essential pillars of a truly comprehensive, integrated, sustainable and evidence-based response.

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