Prevention is not working

I’ve written about this before, but it seems to me the recent surge in interest in male circumcision emanates from the recognition that prevention programs are hard. It is simply very difficult to change human behavior and insist that men wear condoms, cut down on the number of sexual partners, or that women and men (and boys and girls for that matter) abstain from having sex.

I suppose I need better data than news reports to back up this conclusion, but here is at least one Washington Post story that supports my argument:

But beyond the walls of this hospital, Venter says, doctors are not winning — and probably cannot win — the war against the epidemic, because it is spreading far more quickly than doctors are treating its victims. Even as billions of dollars are spent expanding access to antiretroviral drugs, the goal of controlling AIDS in Africa remains remote.

Underlying his frustration are grim statistics: For every South African who started taking antiretroviral drugs last year, five others contracted HIV, the same ratio as on the continent as a whole, U.N. reports say.

But in sub-Saharan Africa, prevention programs have mostly failed to curb the behavior — especially the habit of maintaining several sexual partners at a time — that drives the epidemic, research indicates.

In a sense, this is why countries have turned to treatment which seems more effective and is less politically controversial, but in the long run, the number of new infections will exceed the ability or willingness of Western donors to pay for drugs, even ones that a priced appropriately in the low hundreds of dollars for an annual treatment regimen. There are simply too many people getting the virus.

Certainly, the failure of prevention doesn’t mean abandoning ABC programs or leaping towards the hail mary of male circumcision, but we should be extra concerned that the world community and governments haven’t got it right.

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