Major shift in HIV prevention priorities needed

Researchers say reducing multiple sexual partnerships and providing male circumcision services should be emphasized

Boston, MA -- According to a new policy analysis led by researchers at the Harvard School of Public Health (HSPH) and the University of California, Berkeley, the most common HIV prevention strategies—condom promotion, HIV testing, treatment of other sexually transmitted infections (STIs), vaccine and microbicide research, and abstinence—are having a limited impact on the predominantly heterosexual epidemics found in Africa. Furthermore, some of the assumptions underlying such strategies—such as poverty or war being major causes of AIDS in Africa—are unsupported by rigorous scientific evidence. The researchers argue that two interventions currently getting less attention and resources—male circumcision and reducing multiple sexual partnerships—would have a greater impact on the AIDS pandemic and should become the cornerstone of HIV prevention efforts in the high-HIV-prevalence parts of Africa.

The paper appears in the May 9, 2008 issue of the journal Science.

“Despite relatively large investments in AIDS prevention efforts for some years now, including sizeable spending in some of the most heavily affected countries (such as South Africa and Botswana), it’s clear that we need to do a better job of reducing the rate of new HIV infections. We need a fairly dramatic shift in priorities, not just a minor tweaking,” said Daniel Halperin, lecturer on international health in the HSPH Department of Population and International Health and one of the paper’s lead authors.

The AIDS pandemic continues to devastate some populations worldwide. In most countries, HIV transmission remains concentrated among sex workers, men who have sex with men and/or injecting drug users and their sexual partners. In some parts of Africa, HIV has jumped outside these high-risk groups, creating “generalized” epidemics spread mainly among people who are having multiple and typically “concurrent” (overlapping, longer-term) sexual relationships. In nine countries in southern Africa, more than 12% of adults are infected with HIV.

Halperin, co-lead author Malcolm Potts, Bixby Professor of Population and Family Planning at UC Berkeley School of Public Health, and their eight colleagues say that the current widely used prevention strategies, while having value in some instances, are not as effective at preventing HIV transmission as male circumcision and reducing multiple sexual partners and thus should not continue to receive the bulk of donor investments for prevention, especially in Africa.