Test-And-Treat Model For Tackling HIV Not ‘Common Sense’

In a Guardian opinion piece, columnist Elizabeth Pisani challenges the assumptions made by the “mathematical model that shows that if we test everyone in Africa for HIV once a year and give everyone who tests positive expensive drugs right away and for the rest of their lives, we’ll wipe out new HIV infections within seven years. … Sadly, it’s not that simple,” Pisani writes of what is known as the test-and-treat model.

“For one thing, HIV is most infectious in the few months after a person is first infected. Even if everyone got tested annually, we’d miss most of these new infections. Second, people’s viral load spikes upwards if they get another sexually transmitted infection (STI), or if they stop taking their medicine … Most importantly, antiretrovirals keep you alive and well enough to be out there meeting new sex partners. That’s a good thing, obviously, but it also means that people who have HIV are going to have more chances to pass it on during those times when their viral load is spiky.” After outlining further difficulties she sees with this theory, Pisani concludes that the model is “[a] triumph of optimism over common sense (2/22).

Test-And-Treat Program Could Be A ‘Step Change’ In Global HIV Prevention

“The universal testing and treatment programme proposed by Brian Williams has a good chance of delivering a step change in HIV prevention, particularly if combined with safe sex education and male circumcision,” Mark Henderson, the Times’ science editor, writes in a London Times opinion piece. According to Henderson, antiretrovirals must undergo extensive testing “in African settings” to determine whether the test and treat approach would work. He also highlights the issue of cost. “While containing AIDS would certainly pay for itself in the long run, significant up-front investment will be needed … They are certainly not beyond the combined means of Western and African governments, and philanthropic organisations such as the Bill & Melinda Gates Foundation,” he writes.

Henderson concludes: “To engage these resources, though, firm evidence of efficacy will be needed. That is why the trials that start soon in South Africa are so important” (2/22).

Globe And Mail Opinion Piece Examines Canada, G8 Africa Aid

A Globe and Mail opinion piece – written by Brett House, a senior economist at Columbia University’s Earth Institute, and Desiree McGraw, a former senior policy adviser to Canada’s minister of international co-operation – criticizes Canada’s freeze on increased aid to Africa over questions of accountability and effectiveness. They write: “Let’s be clear: If there’s an accountability deficit on aid, it lies with Canada and other G8 countries that have been long on talk and short on action when it comes to supporting Africa. By some estimates, the G8 has made 55 commitments on international development in recent years. The follow-through has been abysmal. At the 2005 Gleneagles G8 summit, heads of government promised to raise annual global development assistance by $50-billion (U.S.) over five years, with half of this increase earmarked to ‘more than double’ annual aid to sub-Saharan Africa. Only about half of this increase has been delivered by G8 governments, and only a sliver of it directed to Africa.”

The authors conclude: “When G8 development ministers meet in Halifax this April, [International Co-operation Minister Bev] Oda should ask her counterparts to lay out credible, time-bound plans to deliver on their unmet promises – with Canada first in line” (2/22).