Mwanza v. Rakai

The most striking point to me in the Grosskurth article comparing the results of the Mwanza and Rakai trials was the difference in treatment in the two trials between treatment of symptomatic STDs. In the Rakai trial, which showed a lesser correlation between treatment of STDs and decreased prevalence of HIV, treatment of both symptomatic and asymptomatic STDs was provided periodically, not regularly. In Mwanza, in contrast, treatment of symptomatic STDs only was provided regularly, and a stronger correlation between treatment and decreased prevalence was observed.

This distinction seems fairly obvious--- symptomatic diseases means that they are more likely to cause inflamed lesions, which naturally would be more likely to prompt the spread of HIV. I understand that for the sake of the integrity of the experiment it was probably necessary to be more general in the course of treatment, if solely to get a more broad set of results. But, as in the Rakai trial, if the end result of the experiment is a more generalized trend that shows a lesser correlation than a more specific experimental design would show, I feel that it has not served its purpose. The results of the Mwanza trial are more helpful-- they indicate that STD intervention CAN be helpful to prevent the spread of HIV. The Mwanza trial also indicated another principle of medical care that I thought was fairly self-explanatory-- long-term, regular treatments are more beneficial than sporadic mass treatment campaigns, as in the case of the Rakai trial.