HIV funding priority shift call

Sub-Saharan Africa has high rates of HIV infection

Funding for HIV prevention is being wasted on strategies which have little impact, say US researchers who call for a "dramatic shift" in priorities.

Substantial investment in condom promotion, HIV testing and vaccine research has had limited success in Africa, they argue in Science.

Instead male circumcision and reducing multiple sexual partners should become the "cornerstone" of prevention.

Two-thirds of HIV infections globally occur in Africa.

Yet the researchers from the Harvard University School of Public Health said the evidence behind many of the prevention strategies used in African countries with "generalised" heterosexual HIV epidemics was weak.

We need a fairly dramatic shift in priorities, not just a minor tweaking Dr Daniel Halperin, study leader

It comes as a second article published in the British Medical Journal called for UNAids to be shut down as it was distorting health financing.

Roger England, chair of small Grenada-based think tank, Health Systems Workshop, said too much is being spent on HIV compared with other diseases which kill more people.

He said globally HIV causes 3.7% of mortality but received 25% of health aid.

Money would be better spent on improving health systems within countries, he argued.

Priorities

In nine southern African countries, more than 12% of adults are infected with HIV, the US researchers said.

Despite widespread promotion of condom use it has not had a measurable effect on new infections, their review of the research found.

And several studies have shown no consistent reduction in risk of new infection associated with HIV testing.

Evidence for treating other sexually transmitted infections to reduce HIV transmission is also minimal, they said.

But study leader Dr Daniel Halperin said many studies have shown that male circumcision significantly reduces the risk of heterosexual HIV infection.

Three trials in Africa were stopped early after showing at least a 60% reduction in HIV risk.

Furthermore, programmes to promote fewer sexual partners appears to have had a primary role in reducing HIV rates in Uganda, Kenya, Zimbabwe, Cote d'Ivoire, and in urban Malawi and Ethiopia, he said.

After a 1987 "Zero Grazing" campaign in Uganda, the number of people reporting multiple and casual partners declined by over half, he reported.

"Despite relatively large investments in Aids prevention efforts for some years now, it's clear that we need to do a better job of reducing the rate of new HIV infections," said Dr Halperin who is a lecturer in International Health.

"We need a fairly dramatic shift in priorities, not just a minor tweaking."

Responding to the criticism of UNAids, Paul De Lay, director of the evidence, monitoring and policy department said HIV was and still is an emergency requiring an "unprecedented response".

"Even the best health services in the world cannot tackle AIDS alone.

"AIDS funding can and does bolster health systems more widely-providing wins for both AIDS and health in general."

Michael Carter, spokesperson for Aidsmap said: "There is undoubtedly a growing sense of frustration about HIV incidence figures and this inevitably leads to the search for methods of prevention that appear more effective.

"If we've learnt anything from the past quarter of a century it's to be pragmatic in our approach to HIV prevention."

He added: "Circumcision and partner reduction do have a role and will have greater success in some settings than others."

Lisa Power, head of policy at the Terrence Higgins Trust said: "Different strategies are needed for different countries and with the UK's concentration of HIV in specific populations, targeted work is essential."

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