Preventing HIV: From how? to who?

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In May, the world marveled at news that early anti-retroviral treatment of those who are HIV-positive reduced the chance of one partner infecting another by over 96 percent. Now, in a new study led by Dr. Jared Baeten of the University of Washington, researchers found that a group of 6,000 HIV-negative young people in Kenya, Botswana, and Uganda who were given a daily antiviral pill had a 63 to 73 percent decreased risk of contracting HIV over the course of a year; what s more, they believe that, among those who took the pill most regularly, the risk was almost 80 percent less. These researchers say, the question now becomes, Who should be offered the prevention pill?

While AIDS experts such as the Centers for Disease Control and Prevention s Michael Thigpen acknowledge that putting an entire country on anti-retroviral medication is not an ideal solution, they also note that, in countries like Botswana, where the HIV infection rate is up to 50 percent in women aged 18 to 39, a case could be made for widespread preventive treatment with anti-retrovirals. Having the means to prevent HIV and needing to decide how to implement it is a good problem to have, says ACSH's Dr. Gilbert Ross. And, while he notes that a compelling case could be made for widespread administration of anti-retrovirals in countries that are particularly ravaged by HIV/AIDS, he questions exactly where one would draw the line. It s not as if these drugs are without side effects, he says. And they also still come with a significant price tag. Still, he observes, we re clearly making gradual progress toward developing a better program for the global control of HIV/AIDS.