It’s that time of year again. No, not the festive season – not merry Yuletide lights, perfume ads and mistletoe – but time to mark World AIDS Day once more. With many voices hailing the end of AIDS, there does seem to be cause for celebration or at least optimism on this first of December.
Just over a year ago, studies showed that putting people on anti-retroviral drugs (ARVs) as soon as their diagnosis is discovered – an approach called “treatment as prevention” or TasP – lowers their viral load so dramatically that they become largely non-infectious to their partners. On another front, evidence shows that male circumcision can significantly reduce the risk of infection, adding to a palette of biomedical options that includes the use of ARVs to prevent mother-to-child transmission of the virus and that old favourite, the condom. Altogether then, the tone of the AIDS narrative is shifting if not into a festive register then at least towards a more hopeful note.
Research groups at the London School of Hygiene & Tropical Medicine (LSHTM) are engaged in work on these and other developments in the HIV field, from every angle of public health, epidemiology to mathematical modelling, medical anthropology to health economics. If you think PopART means Andy Warhol, for instance, LSHTM has news for you. (For up-to-date information on a school expo for World AIDS Day, see the events page or email firstname.lastname@example.org. )
Thinking about condoms, though, is a reminder that, even with good news, it’s important not too celebrate too soon. Like the new prevention measures hitting headlines, the humble condom is also highly effective and yet, decades on, has failed to stem the tide of the epidemic. Research has identified many of the barriers that have blocked widespread condom use and these must be addressed if breakthrough technologies are to achieve anything like their potential to prevent transmission and save lives. One group at LSHTM was set up to focus on precisely these barriers. STRIVE, a DFID-funded research consortium within SaME, studies the ways in which people’s ability to protect themselves and stay healthy is limited by social and economic factors – by stigma, for instance, or by the few available choices for earning a livelihood within poor or marginalised communities.
With partners in India, South Africa and Tanzania, STRIVE evaluates promising programmes that address these structural factors, for example by taking steps to reduce domestic violence or to regulate the advertising and availability of alcohol. Unlike biomedical or behavioural measures that target individuals, such interventions are designed to make change at the level of the structures that shape people’s choices. Laws and policies are structural factors in this way, as are social norms, and systems such as those to ensure and encourage access to credit and education. STRIVE partners evaluate interventions that address this structural or upstream level and the consortium draws attention to programmes that are successful in reducing risky behaviour and thus HIV vulnerability.
This all sounds good, but aren’t these interventions expensive? – an urgent question in a global recession as HIV funding shrinks. Economists within the STRIVE team work with multilateral stakeholders such as the World Bank and World Health Organisation to analyse the implications of reduced global spending on HIV (read more). Intervening upstream to reduce HIV vulnerability, they point out, invariably yields overlapping benefits for many other development and health outcomes and thus could arguably be financed across sectors (read more). Girls stay in school, boys learn new and less violent ways to grow up as men, communities take on the challenge of curtailing problem drinking, and social entitlements, microcredit and health services are better targeted to reach those who can most benefit from them.
So, even though the end of AIDS may not, sadly, be coming up around the next bend, STRIVE and other LSHTM research groups are working to map the most effective routes to move in that direction. And that’s encouraging news in any season.
Contributed by Annie Holmes, Director of Research Uptake & Influence, STRIVE Research Consortium, London School of Hygiene & Tropical Medicine
Disclaimer: STRIVE is supported by UKaid from the Department for International Development. However, the views expressed do not necessarily reflect the department’s official policies.