Thursday, July 16, 2020

“Corrections on your HIV/AIDS story”

Dear Editor,

I would like to issue a correction to your article of 4 November, 2007
(“International companies profiting from Botswana’s HIV prevention
failures – study”).

I have never attributed any sort of “profit” motive as the
main motivation for people working in the “AIDS industry.” While some experts may not have fully grounded their approaches to fighting the epidemic in the local epidemiological, cultural and socio-economic context, I view this as resulting primarily from an inadvertently “misguided” yet well-meaning urge to help Africans, not from a desire to profit from their suffering.

Also, the article refers to a “new study” that has been “released” by a group with which I am associated at Harvard; I have not authored such a study nor
do I know of such a study.

For your information, although the article suggests that “abstinence” was the reason for the prevention success in Uganda, numerous studies (published in leading peer-reviewed journals such as Science, the British Medical Journal, Lancet, etc.) have shown that it was not abstinence (nor
primarily condoms, although they likely also helped) but rather a marked
reduction in the fraction of people having multiple sexual partnerships which was most likely the key, although not the only, factor implicated in the HIV
decline there (as in Kenya and Zimbabwe more recently). In any event, I
continue to fervently believe, as 150 global experts concluded in our 2004
statement in The Lancet (“The Time has Come for Common Ground on Preventing Sexual transmission of HIV,” by Halperin et al) , that “The time has come to leave behind divisive polarisation and to move forward together in designing and implementing evidence-based prevention programmes to help reduce the millions of new infections occurring each year.”

Dr. Edward Green, who was a co-author on that paper, wanted me to mention
that he fully agrees with this letter.
Finally, if there is room to include it, this conclusion to another
2004 article in The Lancet, by myself and Helen Epstein, could also be
cited, since it well summarizes my views:

“Although no simple solution exists to this complex problem, we believe
that in addition to condom availability and other prevention approaches in
Africa, there needs to be franker discussion and concerted public-health
efforts addressing the dangers of having more than one long-term sexual
partner at a time. Because most Africans do not have exorbitant numbers
of partners, they may not fully realise how dangerous, especially in
regions of high HIV-prevalence, such behaviours actually are. In southern Africa, even people with only two lifetime partners- hardly high-risk behaviour by western standards – need to appreciate just how risky that one extra partner can be if the relationships are long-term and concurrent. The now famously successful Zero Grazing (partner reduction and faithfulness) campaign in Uganda,19,22,23,28,29 coupled with encouraging evidence from other places such as Zambia,25,29 Addis Ababa,1,29 and Kenya,23 suggests that fundamental society-wide changes in sexual norms can occur in Africa, just as in other regions faced with the scourge of AIDS.”

Sincerely,

Daniel Halperin, PhD
Senior Research Scientist
Harvard University School of Public Health
Center for Population & Development Studies
[email protected]
(617) 496-7019

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