Two major HIV researchers say that countries most affected by the epidemic should test whether promoting a national month of sexual abstinence is able to slow the spread of the virus by disrupting the transmission chain during the primary stage - highly infectious - of the infection.
Professor Alan Whiteside of the Division of Health Economics and HIV / AIDS Research (HEARD) at the University of Kwazulu-Natal and Dr. Justin Parkhurst of the School of Hygiene and Tropical Medicine of London (LSHTM), indicate that if mathematical models prove that the idea has potential, nationwide campaigns would have to be conducted to test this hypothesis.
Swaziland is already cherishing the idea, says Professor Whiteside.
HIV levels peak in the period from one month to six weeks after infection, before immune responses begin to control the virus. People at this stage of infection are involved between 10 and 45% of virus transmissions.
If large numbers of newly infected people can be prevented from transmitting the virus for a month, this could have a similar effect to a "firewall," just as trees are felled in a forest to prevent fires from spreading.
Professor Whiteside and Dr. Parkhurst hypothesize one of the reasons why Arab countries have a much lower prevalence of HIV, in addition to the universal realization of circumcision: during the fasting month of Ramadan, believers should refrain from having sex during the daytime hours.
However, while turning people into a religion is not a practical public health strategy, the authors point to the World Health Organization (WHO) 'no-smoking' days and suggest that [even temporary ] can reduce risk behaviors in a population.
"After looking at the national pride and unity shared by citizens in South Africa during the World Cup, I am convinced that community mobilizations can work. This could be a breakthrough in some of the most affected communities. This type of initiative could provide hyperendemic countries with an exceptional and short-term adaptation that is cost-effective, easy to monitor and does not create additional stigma, "said Alan Whiteside.
"It is difficult to change people's behavior on a permanent basis, but when communities mobilize to act together, it is not impossible to imagine regular periods of behavior change shared by whole communities or even an entire country."
The evidence shows that if all people could do this simultaneously, it would have a greater protective effect than if each one tries to do it independently. Of course, this effort would have to be designed to fit local contexts and cultures, but it offers another possible strategy for the fight against HIV, "Justin Parkhurst said.
The authors point out that a month of "safe / sexless sex" will also provide easily verifiable data on the degree of adherence, which would be evidenced by the number of births that would occur nine months after the campaign.
"Given that incidence rates remain so high in southern Africa, we may find that this kind of novel strategy to address the epidemic is a real opportunity for prevention," added Whiteside.
Researchers suggest that the idea should suit different populations, depending on what factor drives the epidemic. Among South African miners, for example, a month 'without commercial sex' might be the right thing to do. In other contexts, it might be worth promoting a month of practicing 'only safe sex'.
"For some people, permanent monogamy may be a difficult goal to sustain over the long term, but 'a month of monogamy' could be a useful starting point. In hyperendemic countries, policymakers, populations and politicians are open to new ideas to address the epidemic, "they conclude.
Reference: Parkhurst J, Whiteside A. Innovative responses for preventing HIV transmission: the protective value of population-wide interruptions of risk activity. Southern African Journal of HIV Medicine, 19-21, April 2010.
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