HIV myths debunked

According to James Shelton, there is nothing to be complacent about. We are still losing ground in the AIDS pandemic. Every day the number of new infections continue to massively outnumber the numbers of people who start antiretroviral therapy in developing countries. As he says, "Most infections occur in widespread or generalised epidemics in heterosexuals in just a few countries in southern and eastern Africa. Although HIV incidence has fallen in Uganda, Kenya, and Zimbabwe, the generalised epidemic rages on. Something is not working. Ten misconceptions impede prevention."

These ten misconceptions are:
1. HIV spreads like wildfire - it doesn't. HIV is only very infectious in the early stages, when the viral load is high. In the years following infection, it is actually quite difficult to pass the virus on. Only about 8% of people whose partner has the virus become infected each year. The problem is more than one partner - at the same time. This seems to be what is underlying the rapid spread of the virus in Africa.

2. Sex work is the problem - no - formal sex work is uncommon in these generalised epidemics. In Lesotho, for example, on 2% of men reported paying for sex in the previous 12 months, while 29% reported multiple partners. So, targeting sex work in prevention campaigns is not very useful.

3. Men are the problem - yes, men's behaviour (multiple sexual partners and so on) probably does contribute to the problem. But in a heterosexual epidemic some women must also have multiple partners. There are many relationships in which it is the woman, and not the man, who is HIV positive.

4. Adolescents are the problem - the disease hits all ages - adolescent women may be infected through sex with older men - but the incidence of HIV increases in women in their 20s and men are infected at even older ages. So prevention messages aimed exclusively at adolescents are less useful than some people assume.

5. Poverty and discrimination are the problem - certainly, these factors may cause risky sex. But, paradoxically, it is the wealthier portions of poorer societies who have higher incidences of HIV than the poorer sections. Wealth equals mobility which equals access to multiple partners. And HIV incidence has declined in Zimbabwe - hardly an example of a wealthy and discrimination free society.

6. Condoms are the answer - they have limited impact in generalised epidemics - but are important for individuals. Most people don't use them.

7. HIV testing is the answer - in theory, yes, this should lead to behaviour change. But the evidence for this is just not there and newly infected people - who are the most infectious - do not test positive.

8. Treatment is the answer - again, yes in theory, but again, the evidence for availability of treatment changing people's behaviour is not there. Indeed, there may be a negative effect, with people believing that now they are on antiretrovirals that they can have unsafe sex - and that because antiretrovirals are available, it's OK to get HIV.

9. New technology is the answer - we will be waiting a long, long time for a vaccine or a microbicide that works - if either are ever developed. Male circumcision, even if widely adopted, will take years to have an effect.

10. Sexual behaviour will never change - homosexual men in the USA at the start of the epidemic showed that this is simply not true - if sex can kill you, people do think twice about it. Kenya and eastern Zimbabwe have also shown that people can spontaneously reduce their number of sexual partners with the threat of a deadly disease.

The real message is - not in the author's words - don't screw around! It is the fact of multiple, concurrent partners that is the main driver of the generalised epidemic. Sorry, Mr Mbeki, promiscuity is the problem - and this must be addressed without fear or favour.

(The interpretation of this article is purely the Editor's).

See the full text on http://www.thelancet.com/journals/lancet/article/PIIS0140673607617553/fulltext