Letters

HIV/AIDS control needs a clear plan of action

Editor – Nelson Mandela’s call for unity at the XIIIth International AIDS Conference (1) highlighted the need for all countries to combine their efforts in the fight against the HIV/AIDS epidemic, particularly in the developing world where HIV infection is mainly concentrated. Most major public health programmes implemented by the governments of developing countries have been planned or advised by WHO, for example, smallpox eradication, the Expanded Programme on Immunization, primary health care, DDT spraying for malaria control, multidrug therapy for leprosy, poliomyelitis surveillance and eradication, and the DOTS strategy for tuberculosis control. There is an urgent need for WHO and UNAIDS to provide such central leadership in formulating similar clear plans of action for HIV/AIDS control.

One important point needs to be highlighted: the preventive strategies should emphasize only the feasible, clear programmes that are urgently required to control the epidemic, and should not contain vague, humanistic plans to incorporate all aspects of the disease which would dilute the strategies and make the task impossible to implement. Other issues not directly related to control could be tackled separately or later. In all the public health programmes mentioned above, plans of action to achieve the specific goals were clearly spelled out.

The strategies planned by WHO and UNAIDS would, of course, have to be implemented by national governments with the help of national AIDS centres and other government offices. Examples of possible HIV/AIDS prevention strategies that could be immediately applied in most countries are: (a) regular broadcasting through television and cinema of short educational spots or songs (2) of a few minutes duration; (b) inclusion of HIV/AIDS education in the school curriculum; (c) vigorous promotion of condom use, aiming at 100%, in all commercial sex establishments; (d) increasing coverage of antiretroviral preventive therapy in pregnancy, ensuring confidentiality and offering counselling; and (e) outreach activities, possibly with the help of nongovernmental organizations, with locally important high-risk groups such as commercial sex workers, injecting drug users, homosexuals, prisoners, migrants, and transient populations.

Clear recommendations by WHO and UNAIDS would no doubt generate proper response from governments in the developing countries, as has been the case concerning other public health problems in the world.

Madhur Dev Bhattarai
Postgraduate Teacher
Department of Medicine
Bir Hospital, Post Box 3245
Kathmandu, Nepal
(fax: 977-1-434914 email: mdb@ntc.net.np)

Conflict of interests: none declared.

1. Nelson Mandela calls for unity at the XIIIth International AIDS Conference in Durban, South Africa. Bulletin of the World Health Organization, 2000, 78: 1169.

2. Bhattarai MD. TV and cinema underused in HIV prevention. Lancet, 2000, 356: 773–774.