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Completing the Public Health HIV/AIDS Alphabet

Posted by plosmedicine on 30 Mar 2009 at 23:38 GMT

Author: Arthur Ammann
Position: President
Institution: Global Strategies for HIV Prevention
Submitted Date: November 01, 2004
Published Date: November 2, 2004
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Dr. Gerberding outlines critical steps for arresting the HIV/AIDS epidemic. She suggests moving ahead with ABC and with "D" for diagnosis and "R" for responsibility. These are good suggestions -- with increased HIV testing and individuals taking responsibility for their role in HIV spread, the epidemic might be slowed. We could continue to add incrementally to the alphabet soup of public health. But instead, we could choose to immediately implement the mainstays of public health - universal testing and contact tracing (1,2,3). Every sexually active individual and every individual at risk for HIV deserves to know their HIV status. Thus, every HIV infected individual must be called upon to be accountable for preventing HIV transmission. Contact tracing should be instituted for HIV just as it is for other infectious diseases. Those who have been exposed to HIV have a right to know how to protect themselves and if they too are infected, to be offered treatment (4).
HIV testing has too often focused on testing of women in a perinatal setting rather than universal testing in routine clinical care. Without universal voluntary HIV testing and contact tracing, we will see the continued tilt of the epidemic toward women, now at 55% of all HIV infections and in all likelihood at 75% - 80% in another 8 to 10 years (5,6). For too long the debate has been that contact tracing will result in physical abuse of women. Confining our definition of abuse of women to physical abuse alone is to have too narrow an ethical focus - HIV infection itself is an abuse of women or of anyone else. Universal HIV testing and contact tracing adds an essential comprehensive public health approach to the epidemic that will be successful in reducing the ever-escalating numbers of new infections.

1. De Cock KM, Mbori-Ngacha D, Marum E (2002) Shadow on the continent: public health and HIV/AIDS in Africa in the 21st century. Lancet 360:67-72.
2. Janssen RS, Holtgrave DR, Valdiserri RO, Shepherd M, Gayle HD, De Cock KM (2001) The serostatus approach to fighting the HIV epidemic: prevention strategies for HIV-infected individuals. Am J Public Health 91: 1019-1024.
3. Ammann AJ (1995). Unrestricted routine prenatal HIV testing: the standard of care. J Am Med Womens Assoc 50: 83-4.
4. The Economist. (Aug 18, 2001) The politics of human rights. Righting wrongs. The Economist 9:18-20.
5. http://www.gatesfoundatio...

6. Joesoef MR, Cheluget B, Marum LH, Wandera C, Ryan CA et al. Differential of HIV prevalence in women and men who attended sexually transmitted disease clinics at HIV sentinel surveillance sites in Kenya, 1990-2001 Int J STD AIDS 14: 193-6.

Competing interests declared: None