"Something is not working. Ten misconceptions impede prevention.".
On this day, I think I will defer to the latest Lancet editorial
Ten myths and one truth about generalised HIV epidemics by James D. Shelton:
And the "one truth":
Truthfully, our priority must be on the key driver of generalised epidemics—concurrent partnerships. Although many people sense that multiple partners are risky, they do not realise the particular risk of concurrent partnerships. Indeed, technical appreciation of their role is recent.6 But partner limitation has also been neglected because of the culture wars between advocates of condoms and advocates of abstinence, because it smacks of moralising, because mass behavioural change is alien to most medical professionals, and because of the competing priorities of HIV programmes.
Fortunately we can enhance partner-limitation behaviour, akin to the behaviour change that many people have adopted spontaneously. State-of-the-art behaviour-change techniques, including explicit messages, that are sensitive to local cultures, can raise perception of personalised risk. Even modest reductions in concurrent partnerships could substantially dampen the epidemic dynamic. Other prevention approaches also have merit, but they can be much more effective in conjunction with partner-limitation. Now, more than 20 years into HIV prevention, we have to get it right.
And on this theme, one could read William Easterly's review of The Invisible Cure: Africa, the West and the Fight Against AIDS by Helen Epstein:
One of the classic works of journalism of the last couple of decades was Randy Shilts's And the Band Played On about the sluggish response to AIDS in the 1980s in the United States, which indicted both the Reagan administration and the leaders of the gay community. I still remember the sense of outrage I felt when reading Shilts's book; it struck just the right note, leaving one both horrified about the tragic incompetence of so many and yet also hopeful that someone, somewhere could do things better next time.
Yet after reading Helen Epstein's masterful new book, the response to AIDS in America now looks in retrospect like a model of courage, speed, and efficiency by comparison with the response in Africa. In the US, the government publicized the threat and funded research, the gay community reduced its infection rates by encouraging less risky sexual behavior, the dreaded breakout into the heterosexual population never happened, and AIDS receded to become a disease that, while still tragic, could in most cases be kept under control with expensive new antiretroviral drugs (ARVs).
The opposite is true in every respect of AIDS in Africa, which was anticipated as a looming crisis already in the 1980s, yet governments, foreign aid agencies, and even activists reacted with denials and evasion. The disease rampaged through the heterosexual population and is still rampaging, ARVs were too late, too costly, and available to too few, and Africa is still in the midst of an epic disaster without a solution in sight. As of the latest figures in 2006, 25 million Africans are HIV-positive, 2.1 million die from AIDS every year, and 2.8 million are newly infected each year.
Or better yet, buy and read the book yourself.