Wednesday, 29 October 2014

Supplying condoms is one thing; getting people to use them is another

WYCLIFFE MUGA writes: In a teaching session conducted by Prof Helen Rees, a really important question was raised; something absolutely fundamental for the public health policy aspects of the fight against HIV.

Here is the question: In light of the steady diminishing in global funding for HIV research, what really is the more important goal: to reduce HIV infection. Or to seek to stop HIV altogether?

In short, should we go flat out for the ideal solution? Or should we be content with doing the best we can, given the limitations that reduced funding imposes?
One (partial) answer is to focus on key populations. For example, in sub-Saharan Africa which accounts for about 42% of all HIV-related deaths and infections and yet is the one part of the world with the lowest access to health services, one might ask: What are the social drivers of this epidemic? Why are people vulnerable, and who are the people most at risk?

In most of Africa, young women are the most at risk. In some parts of the world, the most vulnerable are intravenous drug users. In the US, it is men who have sex with men.

But in the East African coast, intravenous drug use is an escalating problem.

One of the most frustrating aspects of HIV research is that every solution seems to create a fresh challenge. An example is in the use of anti-retroviral drugs in prevention of HIV infection. Pre-Exposure Prophylaxis (or PrEP as it is known) has been found to be dramatically effective with sero-discordant couples (one partner HIV positive; the other negative) and prevents one partner from infecting the other. The logical extrapolation of this is that what works with sero-discordant couples should work just as well with the general population; and so everyone considered to be at risk of HIV infection, should take up the same treatment regimen.

But then here is the question: Would someone who was not already infected agree to take Anti-Retroviral drugs for years on end, to prevent infection? This seems especially unlikely as some ARVs have unpleasant side effects?

While trying to get some idea from online sources of condom use across Africa, for example, I came across this: While the supply of condoms increases year on year, this does not guarantee an increase in their use. Poverty, relationship with parents, peers and partners, limited HIV information and education, gender dynamics, and beliefs and attitudes about HIV have all been found to work against condom use across sub-Saharan Africa – (See more at:

Apparently, supplying condoms is one thing: increasing their use is another.

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