Reading for 10/14

After reading the three articles, I thought the one that compared the Mwanza and Rakai trials was the most interesting of the three. Without that article, I would have concluded that the two trials have contradicted each other and that intervention in sexually transmitted diseases may not actually be a major factor in reducing HIV incidence and prevalence. The data collected from the Mwanza trials may have been a coincidence in that STD prevention works particularly well in that region, but may not be as effective elsewhere. However, after reading the comparison article, I realized that a conclusion can be drawn from the two seemingly contradictory trials, since the trials were conducted so differently. The article explained that the two regions were in different stages of the AIDS epidemic in that HIV prevalence was much higher and more stable in Rakai compared to Mwanza. Thus, STDs will have less of an effect on HIV incidence in Rakai compared to Mwanza and it will be inherently more difficult to reduce HIV incidence by STD prevention. In addition, herpes simplex virus type 2 (HSV-2) was much more common (45%) in Rakai than in Mwanza (<10%). This disease is untreatable, accounting for the fact that STD treatment in Rakai was much less influential to begin with so that it had almost no effect on HIV prevalence. I thought the most striking conclusion from this article is that it shows how STD prevention should be implemented into HIV prevention strategies and that the differences in STD intervention methods used in the two regions was the determining factor for whether HIV prevalence was reduced significantly. This has the most impact on HIV prevention policies in the world today. Instead of using mass treatment like in Rakai, we should instead use the Mwanza trial’s method of intervention, because the article shows that the method of intervention was the key determining factor that changed how effective the intervention was in decreasing the prevalence of HIV.