Preventing the transmission of HIV
After many years it remains the case that we do not really know how to prevent the transmission of HIV. Of course we know the mechanics: that condoms and clean needles and syringes mean that the virus will not pass from one person to another. But we still don’t know the strategies that will get these actions adopted in sufficient numbers to reduce transmission in a society.
One reason is the misinformation and silence about sex. Prejudice drives decisions more than evidence. George Bush devoted lots of funding to HIV but insisted that prevention was based on a model called ABC: Abstain, Be faithful and (if you really must have sex)…..Condomise [sic]. This approach has caused huge confusion. Of course, not having sex at all will prevent HIV transmission but this is unrealistic and undesirable for most people. “Be faithful” might seem logical advice but it has caused many people to be infected; most transmission of HIV takes place in regular partnerships. If one of the partners has HIV from a previous relationship, this “be faithful” advice causes infections. If one (or both) of the partners is only pretending to be faithful (this does happen apparently!) then the couple is hardly going to avoid HIV by following this advice. President Obama has dropped ABC, and many of the other damaging elements of Bush’s PEPFAR programme such as the ban on working with commercial sex workers and the banning of agencies which discuss abortion.
One area where we think we know what to do is preventing the transmission of HIV from a pregnant woman to her baby. By identifying women with HIV and some simple actions, we can virtually eliminate all transmission this way. This has been done in Europe and North America where the number of babies becoming infected vertically is now very small.
However, only 45% of women with HIV globally receive the services. There is also debate in the HIV sector about whether male partners should be involved and whether the long-term health of the woman should be considered or only her child’s.
The evidence promoted at the Coaliton on Children Affected by AIDS conference in Vienna shows that involving men in the process greatly increases the effectiveness of the work. If a male partner has been part of the discussions on testing and other actions, the mother is better supported and more likely to be able to follow good advice. If the man is tested as well, then the family can decide together how to avoid passing on HIV. Where only one partner tests positive, then the counselling and support may help them to cope with this trauma.
One worry though was hearing that the push to get men involved may happen in ways that are not appropriate. One speaker from Zambia said that, in her area, if the husband refuses to come to the ante-natal clinic, the clinic refuse the woman an HIV test. In another presentation, the increased risk of partner violence was noted, but without much attention being put to prevent it. We have to be careful that involving men is not done at the expense of ensuring all women have full control over their health and what services they want. Only this way will get towards the vision of eliminating all childhood HIV.