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
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?
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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.
And while we do these things,
we must continue to search for additional 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.