What's next for HIV prevention? Paying people to be healthy

via aidsmap, By Roger Pebody

Researchers are investigating the impact of offering financial incentives to people who are at risk of acquiring or passing on HIV, the International AIDS Society conference (IAS 2011) in Rome heard last week.


A large study in the United States is looking at whether a test-and-treat approach should be supported by offering incentives to newly diagnosed people who attend medical services and maintain an undetectable viral load.

In sub-Saharan Africa, a number of studies are investigating whether providing incentives to adolescent girls who remain in education reduces their long-term HIV risk.

Such approaches are not without their critics, but those participating in a conference symposium on the topic mostly felt that these interventions are trying to tackle structural factors and have the potential to be effective, especially when used alongside other prevention interventions.

“We shouldn’t look at behavioural economics as the new magic bullet,” commented Professor Quarraisha Abdool Karim of the Centre for the AIDS Programme of Research in South Africa (CAPRISA). “This fits into a broader combination approach,” she said.

As well as cash, incentives may take the form of food or shopping vouchers. They are sometimes called conditional cash transfers, and the approach is sometimes referred to as contingency management.

The idea is already widely used in the development field (often aiming to impact poverty or education), and increasingly in relation to health.


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Pope's condom comments are "dangerous and irresponsible"

Such outrageous comments are not appropriate coming from the highest office in the hierarchy of the Catholic Church.

20 March 2009 (Geneva, Switzerland) - Pope Benedict XVI ‘s comments on the role that condoms play in preventing the further spread of HIV are irresponsible and dangerous, says Julio Montaner, President of the International AIDS Society (IAS).

On March 17, 2009, while traveling to Cameroon, the Pope addressed the media, calling AIDS “a tragedy that cannot be overcome by money alone, that cannot be overcome through the distribution of condoms, which can even increase the problem”. This is the first time that Pope Benedict has directly spoken out against the use of condoms. While the historic stance of the Roman Catholic Church against contraception use is widely known, Benedict’s predecessor John Paul II never spoke out publicly against the use of condoms to prevent HIV infection.

“There is not a shred of evidence to suggest that condoms can increase HIV transmission – absolutely the contrary,” said Dr. Montaner. “Male and female condoms, used correctly and consistently, can reduce the risk of sexual transmission of HIV by 80-90 percent.”

IAS Executive Director Craig McClure further condemned the Pope’s remarks. “This is the first trip to Africa by Pope Benedict, a continent that has been ravaged by AIDS. As of 2006, according to the Vatican, over 17% of the total African population practices Catholicism. The numbers are growing each year. Catholics throughout Africa rely on the spiritual guidance of the Pope. To suggest that condom use contributes to the HIV problem is not merely contrary to scientific evidence and global consensus, it contributes to fueling HIV infection and its consequences - sickness and death. Such outrageous comments are not appropriate coming from the highest office in the hierarchy of the Catholic Church.”

Dr. Montaner added, “While condoms are not the only solution to combating HIV, they are a critical, cheap and cost-effective element of a comprehensive approach to HIV prevention. Instead of spreading ignorance, the Pope should use his global position of leadership to encourage young people, who are our future, to protect themselves and others from HIV infection using all the tools we have at our disposal, including condoms. His remarks are insulting to the tireless efforts of committed scientific, public health and human rights leaders around the world to protect the poorest of the poor from HIV infection.”

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The IAS is the world’s leading association of HIV professionals, with more than 13,000 members from 188 countries working at all levels of the global response to HIV/AIDS. IAS members represent scientists, clinicians, public health and community practitioners on the frontlines of the epidemic. The IAS is the lead organizer of the biennial International AIDS Conference and the IAS Conference on HIV Pathogenesis, Treatment and Prevention, which will be held in Cape Town, South Africa in July 2009.

IAS Conference Opens in Sydney - Calls for Universal Access to Prevention and Care

SUNDAY, 22 JULY 2007


5,000 SCIENTISTS, HIV CLINICIANS, AND COMMUNITY LEADERS CONVENE IN SYDNEY, AUSTRALIA TO REVIEW IMPORTANT ADVANCES IN HIV RESEARCH


4th IAS Conference on HIV Pathogenesis, Treatment and Prevention Opens with Call for Expanded Research to Strengthen Global Scale Up of HIV Prevention, Care and Treatment

Sydney, 22 July 2007 - With important scientific advances setting the stage, the 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2007) convenes in Sydney, Australia today, with organizers calling for even greater vigilance to ensure universal access to HIV prevention and treatment, and expanded research to inform and strengthen the global response to HIV. IAS 2007 is hosted by the International AIDS Society (IAS), in partnership with the Australasian Society for HIV Medicine (ASHM). The conference incorporates the 19th Annual ASHM Conference.

"With fewer than one-third of people living with HIV in low- and middle-income countries having access to life-saving medications, and still fewer with access to proven prevention services, such as condoms and sterile syringes, the goal of universal access by 2010 must remain a priority," said IAS President Dr. Pedro Cahn, International Conference Co-Chair and Director of Fundación Huesped in Argentina. "Science has given us the tools to prevent and treat HIV effectively. The fact that we have not yet translated this science into practice is a shameful failure."

Emphasizing that "good research drives good policy and programming," the IAS and ASHM recently issued the Sydney Declaration, a global sign-on letter that urges governments and donors to allocate 10 per cent of all resources dedicated to HIV programming for research. In their remarks at the Opening Session, the conference co-chairs stressed that new research investments cannot come at the expense of prevention and treatment programmes, and that such investments must not be seen as an additional burden, but as a critical way of determining what works best and why.

"It is our responsibility as researchers, as the drivers of the research locomotives that carry HIV treatments forward, to ensure that clinical and prevention research, as well as capacity building and basic science, continue to thrive in the most affected countries," said Prof. David Cooper, IAS 2007 Local Co-chair and Director of the National Centre in HIV Epidemiology and Clinical Research, University of New South Wales. "Funders must understand that good programming can only succeed on the back of solid research."

Some of the many important scientific findings to be presented and discussed at the conference include:
* The development of novel treatments that offer new hope to persons in whom HIV has developed resistance to existing medications;
* New biomedical prevention strategies available and others on the horizon, such as female-controlled microbicides, male circumcision and the use of antiretrovirals to prevent infection (referred to as pre-exposure prophylaxis, or PrEP);
* New knowledge of HIV pathogenesis and the mechanisms through which HIV causes immune deficiency;
* Operations research detailing what we've learned, to date, about what is working on the ground in communities across the globe; and
* Updates on the clinical implications of an ageing population of people living with HIV, as well as on paediatric treatment issues.