Treatment of AIDS will require targeting the regions and populations most affected

Published: December 1, 2014

The Washington Post
Michael Gerson
Original Article: 

My college roommate — the most immediately likable person I’ve ever met, a man who would now be such a present to the world — died of AIDS at the age of 30. Back then, people with the disease did not so much die as fade, becoming gaunt and ghostly images of themselves, as the virus gradually destroyed enough T-cells to cut their ties with the flesh. Metaphors don’t really capture the horror. Declined? Withered? At any rate, he died.

“Whether Ebola, HIV or malaria, infectious disease epidemics are controlled by focusing where new infections are occurring,” Mark Dybul, executive director of the Global Fund, told me. “For example, in Kenya, 53 percent of new adult and 73 percent of new child HIV infections are from five of 47 counties. Rates are highest among fisher folk, young women who trade sex with them and MSM [men who have sex with men]. If we focus on high-level endemic locations and populations, we can bend the curve rapidly and move to bring the HIV epidemic under control.”

Disease experts now have a set of proven HIV prevention methods: early treatment, male circumcision, condoms and the prevention of mother-to-child transmission. They have increasingly specific data on the geographic regions where infections are concentrated. They have a good idea of the highest-risk and hardest-to-reach groups: MSM, transgender people, people who inject drugs, children (who get treatment at lower rates) and young women. (Gender-based violence remains a major problem. In Swaziland, for example, 43.5 percent of females 13 to 24 report unwilling first sexual intercourse prior to age

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