Treatment is prevention
The most encouraging development in the conference was
the laying to rest of the old opposition between HIV
prevention and treatment.
"Treatment is prevention", answered Peter Piot. The evidence
came from a host of programmes all over the world.
One of the few positive Africans on treatment to address the conference
was Fred Manandi, 42, a farmer from Malawi. His village was chosen for
a pilot Aids treatment project by Médecins sans Frontières
(MSF).
Fred's message was that the drugs were a prevention tool as well as saving
his life. "My neighbours all knew I had Aids but no one talked about
it, they just stopped coming round. This is why my country is dying in
silence. Now I have a future, I can tell my children I have Aids and the
neighbours come round again. The treatment is the best tool against the
stigma."
Another example came from the western hemisphere's most afflicted country,
Haiti. Dr Paul Farmer talked about a treatment project he runs there.
It shows how developing-world ways of providing HIV treatment could work.
Lab tests are not available, so treatment is based purely on symptoms.
People with active TB (the most common Aids-defining illness) get TB drugs.
Those with additional Aids symptoms get antiretrovirals too - 12 per cent
of all those testing positive. They are provided by 'accompagnateurs',
community health workers who cycle round the villages every day and provide
directly-observed therapy.
The Haiti project again provided evidence that treatment demolishes stigma.
"Before I began therapy no one would buy things from my shop,"
one patient told Paul Farmer. "But now my wife has returned and my
children are no longer ashamed to be seen with me."
Prevention is treatment
Even programmes where the goal is to prevent HIV have had unexpected spin-offs.
One trial gave 500 women sex workers in the Kibera slum area of Nairobi
the antibiotic azithromycin once a week, to see if HIV transmission could
be slowed by preventing other sexually-transmitted infections.
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The results aren't in yet; we don't know if the antibiotic stopped STDs. But the trial certainly
