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New World Bank AIDS Chief Says Prevention Challenges Remain

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Joe DeCapua

The new head of the World Bank’s Global HIV/AIDS Program says much more needs to done to lower infection rates.

Dr. David Wilson, a Zimbabwean national, takes over the job just prior to this month’s 18th International AIDS Conference in Vienna.  He says familiar challenges remain some 30 years into the epidemic.  “I think that the major challenge 30 years on is the challenge that we faced 30 years ago.  And that is making prevention work.”

He says there have been some “striking prevention successes” in concentrated epidemics in the North, Asia and Latin America.  But “immense challenges” remain in Africa, especially Southern Africa.

Epicenter

“You’ve got a band of about 10 countries with two percent of the world’s population and a third of their HIV infections.  But I think we’re starting to see some really exciting prevention developments in Southern Africa,” he says.

This includes increasing acceptance of male circumcision.

“We know that male circumcision is the single most effective prevention tool that we have,” Wilson says.  And countries in Southern Africa are now really seriously beginning to expand their male circumcision programs.  There’s a determination and a desire to succeed.”

There’s also progress in behavior change, including efforts to reduce multiple or concurrent sex partners.  “These have also been taken up with great urgency by governments in Africa now.  I think prevention is looking more hopeful than it has for a long time,” he says.

Successful prevention makes sustained treatment programs possible.

“Through that combination of effective prevention and sustained treatment we can really arrest this epidemic.”

Condoms, abstinence

Some have called for concentrated safe sex programs by individual countries.  For example, South African professor Alan Whiteside agrees that innovative thinking is needed.  He and Oxford professor Justin Parkhurst say perhaps intense national month-long campaigns that really promote safe sex – including condoms and abstinence – could greatly interrupt infection cycles in many countries.

Dr. Wilson says, “The focus on concerted behavior change is very necessary.  I think it needs to be sustained rather than simply for a month.  I think what we’ve seen with HIV prevention after 30 years is what a tenacious and dogged virus this is.  And it doesn’t let up and our prevention programs have to be equally sustained.”

AIDS 2010

The 18th International AIDS Conference – the world’s largest AIDS gathering – will be held in Vienna from July 18th through the 23rd and will place an emphasis on the epidemic in Eastern Europe and Central Asia. The theme is “Rights Here, Right Now.”

“Vienna was chosen as the conference venue partly as a gateway to Eastern Europe.  And in Eastern Europe, we have epidemics, which are overwhelmingly driven by injecting drugs use, which in cases of countries such as Ukraine are significant epidemics,” he says.

But there’s an opportunity to turn things around.  Wilson says the tools exist to deal with the problem; now the will and commitment are needed.

“We do know that if we do the right programs for injecting drug users by providing clean needles and syringes – and by providing access to opiate substitution therapies – we can make a difference,” he says.

Recently, AIDS 2010 released the Vienna Declaration, which calls for a radical change in international anti-drug policies.  Among its recommendations is the decriminalization of injection drug use and treating the issue as a health problem.

“We need to present public health policies in ways which are most acceptable to the countries in question.  And I certainly think that an approach that emphasizes public health rather than policing is important,” he says.

“If we simply focus on clean needles and syringes and opiate substitution, without also promoting programs to reduce drug addiction, we do isolate ourselves from the wider society and decision makers.  So I think it’s an excellent principle, but it needs to be balanced against important political considerations we face.”

Flatline Funding

Many HIV/AIDS activists and NGOs this year have accused international donors of flatlined funding as they try to recover from the global economic crisis.

“I think that it is true that we are in a context when HIV money is either flat or trending towards flat,” says Wilson.  And I think it is true that we face competing challenges from other health issues.”

Those challenges, he says, makes it important to make better use of existing funds and resources.  “We’re not in a world where resources for HIV will continue to increase at the pace they increased in the past,” he says.

Wilson joined the World Bank in 2003, working in HIV/AIDS programs for such countries as South Africa, Kenya, Nigeria, India, China, Vietnam, Lebanon and Papua New Guinea.

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