One of the most urgent problems in HIV/AIDS
policy is in deciding how best to allocate resources toward preventing
new infections or treating infected individuals.
An analysis by Joshua Salomon and colleagues in the premier open-access
journal PLoS Medicine, published online January 11, 2005, suggests that
an exclusive focus on one or the other of these alternatives will yield
minimal benefits--failing to integrate the two approaches could have a
catastrophic effect on the global toll of HIV/AIDS by 2020. In this
modeling study the authors analyze the epidemic in sub-Saharan Africa
(where three-fourths of deaths from AIDS occur). With no change in
current levels of prevention and care, it is predicted that there will
be 3.7 million new HIV infections and 2.6 million adults dying of AIDS
in this region each year within the next two decades. The authors
predict that combining effective prevention and treatment efforts,
however, could yield substantially greater benefits than the sum of the
two alone--lowering projected new infections by 74% and projected
annual mortality by half. These percentages translate into 29 million
new infections and 10 million deaths averted between 2004 and 2020.
While treatment itself can be life-saving, long-term reductions in AIDS
deaths will be achieved only if new infections are curbed. What is
more, campaigns to expand treatment access in poor countries will only
be sustainable if prevention efforts are strengthened at the same time.
As the authors say: "Treatment can enable more effective prevention,
and prevention makes treatment affordable. Sustained progress in the
global fight against HIV/AIDS will be attained only through a
comprehensive response."