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August 6, 2008
 Behavioral Approaches Overlooked in AIDS Fight By LAWRENCE K.

MEXICO CITY  While the world awaits findings from new
trials, millions of people are becoming infected because
governments are overlooking studies showing that behavior modification
works, AIDS experts said Tuesday.

Among the behavior modifications the experts cited: promoting safer sex
through delayed intercourse and the use of
decreasing drug
providing access to needle exchange programs and promoting male

But none of the measures alone offer a simple solution to preventing
infection with H.I.V., the virus that causes AIDS, the experts said in a
number of reports and news conferences at the 17th International AIDS
Conference here.

The experts said characteristics of the global epidemic varied greatly among
and within countries, most of which were not focusing prevention resources
where their epidemics were concentrated. Combining these measures and
delivering them on a wider scale is crucial to reversing the global H.I.V.
epidemic, they said.

Health workers have had initial successes in providing antiretroviral drugs
to treat an estimated three million people worldwide. But tens of millions
more people need the drugs, and additional millions are now becoming

The world cannot treat its way out of the AIDS epidemic, many experts have
long said, and a scientific debate exists over the extent to which
antiretroviral therapy can reduce transmission of the virus. A pressing need
exists to combine H.I.V. prevention and treatment efforts, experts said

Researchers involved in each field "need to get married today," said Dr.
Myron S. Cohen of the University of North
"We need to be one community."

A 50-member panel known as the Global H.I.V. Prevention Working Group, which
is supported by the Bill & Melinda Gates
released a report saying that prevention efforts must address a number of
perception problems.

One is misplaced pessimism about the effectiveness of H.I.V. prevention
strategies. A second is confusing the difficulty in changing human behavior
with an inability to do so. A third is a misperception that because it is
inherently difficult to measure prevention success, those efforts have no
impact, the report said.

In the wake of three scientifically controlled studies showing that
circumcising adult men helps prevent H.I.V. infection, some progress has
been made in offering the procedure. But no country has succeeded in fully
educating its public about the benefits of circumcision, according to PSI, a
nonprofit organization in Washington.

Dr. Adeeba Kamarulzaman of Malaysia said that outside Africa, about 30
percent of H.I.V. infections were among intravenous drug users. But because
of stigma and a lack of resources, the world is failing to provide measures
like methadone and needle sharing that can help such people.

Meanwhile, The Lancet, a medical journal published in London, released a
series of papers on H.I.V. prevention to be published on Saturday.

"Behavioral strategies need to become more sophisticated," and "that task is
not easy," Thomas J. Coates of the University of California at Los Angeles
wrote in one article. In expanding prevention programs, he said, governments
must be sure that they put in place "the right programs."

Dr. Jorge Saavedra, who directs Mexico's H.I.V.-AIDS program, said that
national AIDS responses needed to involve more gay and bisexual men in
planning ways to reach high-risk individuals. If political leaders do not
follow the epidemiological and scientific evidence and direct efforts where
they are most needed, "we will lose the fight against H.I.V.," he said.

Michael Balter
Contributing Correspondent, Science
Adjunct Professor of Journalism,
Boston University

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