highlighted in several presentations. Two studies from the US and Europe followed 700 people and found that only two became HIV positive after a post-exposure course of
antiretrovirals.
A report from the Congo showed that of 111 who had received antiretroviral
therapy following rape, none developed HIV infection, and only three experienced
side effects.
And pre-exposure prophylaxis - 'chemical vaccination' - was a major new
strand at the Barcelona conference. This means giving antiretrovirals
to prevent infection in those who are at continual high risk - for instance
sex workers or HIV negative partners of positive people. Microbicides
incorporating anti-HIV drugs like tenofovir and the new non-nucleoside
dapivirine are also undergoing trials.
Trials have also looked at continuous low-dose 'presumptive treatment'
with antibiotics to prevent sexually transmitted diseases - and to see
if the HIV transmission rate also falls. Two studies have placed South
African gold miners and Nairobi sex workers on antibiotics to see if STDs
and HIV transmission could be prevented, though whether the HIV transmission
rate was reduced has yet to be revealed.
Circumcision
Dr. Helene Gayle mentioned male circumcision as a possible mode of HIV
prevention in the developing world - something which is still very controversial.
At a press briefing she said: "If male circumcision offers 50 per
cent protective effect, why has this not been discussed more seriously,
when we're investing so much in microbicides that report 60 per cent success?"
Although 21 out of 27 observational studies have found a reduced risk
of infection among uncircumcised men, questions remain about whether lacking
a foreskin works as a preventative, or whether cultural behaviour associated
with circumcised men (Moslems, who are circumcised, do not use alcohol,
for instance) explains the difference.
The first intervention study is underway in Kenya, circumcising men between
18-24 and following them for two years to see whether circumcision alone
is protective. It might just be circumcision
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during infancy that is effective in preventing transmission.
To add to the confusion, two studies from India and Brazil
found that being uncircumcised
