The proposal is spearheaded by Professor Brian Williams of the South African Center for Epidemiological Modeling and Analysis (SECEMA). It calls for blanket HIV testing for most of the world’s population, and those found HIV positive would be put immediately on a lifetime course of anti-retroviral drugs.
Past and Future
Professor John Hargrove, director of SECEMA in Stellenbosch, says, “What we’ve done in the past with HIV is try every manner of means that we can to stop people infecting each other. But generally that’s been by way of trying to change the way they behave, to convince them that they should use condoms, that they should only have one partner and so on and so forth,” he says.
However, that approach has not always been successful.
“In particular, we are seeing very little sign in South Africa, Lesotho, Botswana of any great change in behavior and certainly no great decline in the HIV prevalence.”
Hargrove says Williams bases the strategy on mathematical models.
“If you were in a place where you’ve got very high HIV prevalence, if you were to test the whole population, on average once a year and start people immediately on anti-retrovirals as soon as they were HIV positive, then you could actually reduce the incidence sufficiently that you would drive the epidemic to extinction within the foreseeable future. That is of the order of 30 years. I think that’s what’s radical about it.”
The logic behind it
“If you reduce the viral load, the amount of virus in the blood, then you radically reduce the infectiousness. So, if in fact you get people very soon after they are HIV positive and put them on anti-retrovirals, you reduce the aggregate viral load in the entire population. And therefore you will reduce the rate at which new infections occur,” he says.
By putting people on treatment sooner rather than later and by continuing current treatment programs, overall new infections might be held in check.
“Of course you will still have a lot of HIV-positive people in the population, but slowly as people just die out…. The mathematics of it simply indicate that if we manage to do this…this will be the logical outcome,” he says.
Targeting the most sexually active
The head of the South African Center for Epidemiological Modeling and Analysis says, for example, in Botswana the highest proportion of people on anti-retrovirals are those over 40 years old.
“But those people who are much more sexually active,” he says, “the people in their late teens and early 20s, who are HIV positive, they are very, very seldom on anti-retrovirals. So those people who are most likely to spread the infection are the least likely to be on anti-retrovirals. That’s the essential point.”
Such a testing program could raise privacy issues in many countries. Hargrove says the strategy does not call for mandatory HIV testing.
“We are not suggesting at all that there will be any form of coercion. It would just be suggested to people very strongly that they may want to consider having an HIV test,” he says, “And that if in fact they are HIV positive, and if they want to, they will get free anti-retrovirals and they will have it for the rest of their lives.”
The idea of putting people on AIDS drugs long before their immune systems collapse has been circulating for a while. Critics say one of the problems is that such a move could break the budgets of national AIDS programs in many countries. Hargrove disagrees.
“The cost actually will be approximately the same over the next 40 years whether we continue what we’re doing right now or if we put into place what Brian (Williams) suggested we do. The big difference is that if we continue the way we’re going now and if we do not manage actually to drive down (HIV) incidence by other means, then in 40 years…we will still be faced with the same costs,” he says.
The South African professor says, however, “If we put in this more radical approach and reduce incidence to very close to zero, (in) 40 years…we will not have a problem to face.”
The plan was presented to the American Association for the Advancement of science meeting in San Diego, California.