Friday, March 6, 2009

AIDS Cure: Good... AIDS Prevention: Better

There has been a lot of buzz today about the renewed call to find a cure for AIDS. And let me say, clearly and unequivocally, that I can’t think of anything better. There is a real danger, in an era when antiretroviral drugs are so effective at controlling the disease, that we forget that a cure would be much, much better, even transformative. So, bravo.
But….. I always worry that these biomedical solutions, real or imagined, drain energy and attention from the crying, urgent need to intelligently deploy the prevention tools we already have at our disposal, or to develop new, better ones. (Please see my ongoing posts on “AIDS Prevention 2.0”) The medical model--the idea that enough money to enough scientist in enough labs can solve any problem--is so appealing to our way of approaching the world, and yet the dividends for the African AIDS epidemics have so far been meager.
Even more deeply, we tend to assume that more money equals better results. And while that is often true, it’s worth remembering that the two most important success in AIDS prevention in sub-Saharan Africa came with little money, or Western interference. Those of course were Uganda in the late 1980s and early 1990s, then again in Zimbabwe in the late 1990s and early 2000s. The first saved at least 1 million lives by PREVENTING new infections. The second saved at least 600,000 lives the same way. In both cases, shifts in sexual behavior were the key. In those two countries alone, the number of saved lives exceeds the total number of people on ARVs throughout Africa.
Now I accept that there are real challenges in converting those experiences into new programming. Zimbabwe, in particular, has conditions nobody would want to replicate elsewhere (My story on the Zim situation:
But isn’t it clear that we should be working like hell to answer those challenges? We must figure out what elements of the Uganda/Zim successes can be used elsewhere. In the meantime, let’s hope a cure gets closer too.
Think I'm crazy? Please hit "Comments" below and tell me why....