HIV Prevention Strategies - South Africa

In the United States, HIV prevention usually involves one of two mindsets. There are those who support educating the population on consistent and correct condom use in order to prevent the transmission of the disease while others urge the promotion of abstaining from sex until marriage. While these strategies tend to have some success in the US, some researchers are arguing that what works in one nation does not necessarily work in another nation. Researchers from the University of California at Berkeley and the Harvard School of Public Health teamed up to determine that these normal HIV strategies are not having the expected impact in South Africa.

The researchers on this study have determined that the strategies currently being used in South Africa may be based on faulty scientific logic. The prevalent theory is that war and poverty are major reasons why AIDS has spread so rapidly throughout Africa. Researchers on this latest study feel these reasons might simply be loose deductions with not enough research backing them. Also, this study proposes that circumcising the male population and advocating monogamy would be more effective in those regions of Africa that have been the hardest hit with AIDS. One of the head researchers, Daniel Halperin, states, “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.”

Despite what may appear like the media’s lack of focus on AIDS, it is still a disease that is causing devastation to many nations. Most regions that have high rates of HIV are due to cases caused by homosexual or bisexual sex, drug use and sex workers. What makes Africa different is that their high-risk sectors also include portions of the population that have multiple overlapping sexual partners. With roughly 12% of its population currently carriers of HIV, there is an immediate need to determine how to handle the situation in a more effective manner. The consistent and correct use of condoms is one very large way HIV prevention is promoted. While the use of contraceptives is extremely effective at combating AIDS in countries where there are many sex workers, researchers in this particular study feel that pumping most AIDS/HIV prevention money into this strategy in a country like Africa where HIV is transmitted mainly through long-term heterosexual relationships will prove unsuccessful and costly.

One thing researchers in this study have noted is that data has demonstrated that male circumcision has dramatically reduced HIV infection cases in this region. An example of this is in western Africa where HIV rates are relatively low due mainly to the fact that male circumcision is the norm. The co-author on this study, Malcolm Potts, states, “It is tragic that we did not act on male circumcision in 2000, when the evidence was already very compelling. Large numbers of people will die as a result of this error.” Halperin goes on to say, “The vast majority of donor investments in HIV prevention in the generalized epidemics of Africa continue to go to approaches for which the evidence of actual impact is increasingly unclear. Many of these approaches, such as HIV testing and treating other STIs, do have important public health benefits, and should be continued, but not because we believe they will definitely have a major impact on reducing HIV infections. Meanwhile, there is still some foot dragging on more fully implementing those approaches for which the evidence is much stronger, namely to scale up safe, voluntary male circumcision services, and to more assertively promote partner reduction.”