Reading Response for 11/4

This article was yet another confirmation that there is not (at least, not yet) a quick and simple way to prevent the spread of HIV. While treatment does decrease transmission to an extent, the benefit is largely outweighed by the increased life-expectancy of the patient. In the "pessimistic" behavior change scenarios, ART actually increased HIV prevalence! In many of the cases they tested, ART also increased resistance rates.

These two negative outcomes of ART are sure to be part of ethical and policy debates about the provision of treatment. From an ethical point of view, I still believe that treatment should be available to everyone who needs it, a view that I realize is pretty idealistic. However, this paper is making me reexamine the nuances and complexities of that belief. I hope that the evidence of this model is not used as an excuse for international powers to do less to help populations suffering from a high burden of HIV/AIDS. One of the main policy recommendations that I drew from this article is the need to create comprehensive prevention and treatment programs. Treatment alone is not going to stop the spread of disease, and prevention alone ignores human need. Comprehensive programs demand a lot more resources, but it seems from the evidence presented in this paper that half-hearted efforts are almost worse than no effort at all!

I would be interested to know more about how this model decided on the 85% figure of HIV/AIDS patients who increase sexual activity after beginning treatment (the "pessimistic" model). In this model, behavior change seems to be one of the most influential factors on prevalence level, which further supports the idea that comprehensive treatment/prevention programs that address long term behaviors are needed. Facilitating behavior change is by no means a quick, cheap fix, so implementing this change will be difficult. I'd also be interested to know how the implications of this model relate to the possibility/efficacy of a prophylatic vaccine.