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Figuring Out Which AIDS Prevention Programs Work

Unprecedented amounts of money are going to prevent the spread of HIV and AIDS. But, as VOA's Carol Pearson reports, finding out which prevention programs work is often difficult.

Billions of dollars have gone to fight the spread of HIV and AIDS.

The money has come from the U.S. and other governments, the World Bank and private sources such as the Bill and Melinda Gates Foundation.

Much more than money is needed, according to Martha Ainsworth of the World Bank. "We're now at a point where there is much greater political commitment from the countries," she says. "There's much, much more in the way of finance out there to stop the epidemic. But we now need to move from generating commitment and mobilization to demonstrating results on the ground, in terms of preventing the number of new infections and keeping people alive."

Ms. Ainsworth says, there is not always an obvious connection between AIDS prevention programs and their effectiveness. "We have very little evidence in many of the countries between the links of what was actually done and what those outcomes are. We can't distinguish between whether this is the normal outcome of the epidemic or a result of public policy."

She says it is nearly impossible to find out how many people did not get AIDS because a prevention program worked.

Program evaluations are not scientific. And what works in one country does not necessarily work in another, something Debrework Zewdie, the World Bank's Director for the Global HIV/AIDS program, has emphasized.

"If you take some of the generalized epidemics in Africa, for example, it is mainly heterosexual transmission," says Ms. Zewdie. "In some of the countries, this epidemic is being fueled by specific risk behavior groups. If you go to Eastern Europe, on the other hand, the risk behavior group which is fueling the epidemic is injecting drug users. So you need two different programs in these two parts of the world to address the epidemic."

There are also other considerations.

Michele Orza is with The (U.S.) President's Emergency Plan for AIDS Relief. “Are new HIV infections really being prevented? Are people infected with and affected by HIV/AIDS living longer, healthier lives?"

Cyril Pervilhac from the World Health Organization said at a conference held earlier this year it is difficult to get good program evaluations. He says program organizers need to realize the evaluations are not meant to be criticisms.

He said it is important to treat local program operators as partners in the evaluation. "The recent phone call I had from the team leader was saying that he very much appreciated this participatory approach, that is, involving the countries and W.H.O. at different levels in this process."

Ainsworth says the evaluations are further complicated because sex and other risky behaviors responsible for the spread of AIDS are still taboo topics in some countries.

AIDS has social, moral, economic and political considerations, and, she says all of these concerns need to be addressed in order to successfully fight the disease.

Add these complex issues to medical budgets already stretched thin, and she says it is easy for countries to ignore the spread of AIDS, at least in the beginning.

Ms. Ainsworth, “It's invisible largely in the early years when it is spreading. People don't get sick until about 10 years after they've become infected, so whereas we'd like to get governments to act early, the problem is, if they act early, there's no one visibly ill, so they don't think there's a problem."

Experts, such as Christian Voumard, the UNICEF representative in China, have been concerned about potential AIDS explosions in this populous country.

"Twenty percent of China's populations are young people. And this is also about 20 percent of the world's young population. If we are able to get them to know the facts, to share them with their friends, their families, their communities, and to care about other young people and children, they will make a huge difference for the global campaign on Children and AIDS."

China now has youth ambassadors on AIDS that work with UNICEF to prevent the spread of AIDS among China's young people.

Ainsworth says, just as the world needs a variety of programs, donors also need to know which programs to fund in order to stop a disease that has already claimed too many lives.