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Education And Debate

Partner reduction is crucial for balanced “ABC” approach to HIV prevention

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7444.891 (Published 08 April 2004) Cite this as: BMJ 2004;328:891

Rapid Response:

Partner reduction for AIDS prevention: good luck

Editor -- HIV prevention advice for countries experiencing
generalized epidemics has been rich in theory and poor in data (1). It is
distressing to note that, twenty years into the epidemic, reliable
evidence for the efficacy of specific prevention recommendations remains
elusive. The proposal by Shelton and colleagues (2) that sexual partner
reduction should be emphasized is cogently reasoned and compassionately
argued; yet, as they point out, support for its epidemiologic importance
“rests largely on ecological and…observational evidence…” and “suggest
that partner reduction could (emphasis mine) have a major effect” (2).
While agreeing that public health workers have little choice but to heed
the authors’ proposal, I would not be surprised if no appreciable
reduction in HIV incidence would result as a consequence of its
implementation.

In brief, prepare for disappointment. A series of anomalies in the
orthodoxy that “heterosexual sex” accounts for most HIV transmission in,
for example, sub-Saharan Africa has been noted (2) and remains empirically
unresolved. Hence, not only is it not “obvious” that “multiple sexual
partnerships” drive AIDS epidemics globally (as patterns of HIV
propagation in Eastern Europe, in former Soviet Union countries, and in
China indicate) but critical thresholds for multiple sexual partnerships
have not been established for HIV transmission dynamics. Hard data, not
new insights, are what’s really needed to provide confidence that specific
HIV prevention advice will be efficacious. I agree with the authors that
“…it is time for the international community to unite around a balanced,
evidence based …approach” (2). The challenge is to secure valid data (1).

John J. Potterat, Independent Consultant

301 South Union Blvd., Colorado Springs CO 80910 USA

References

1. Brody S, Potterat JJ. Establishing valid AIDS monitoring and
research in countries with generalized epidemics. Int J STD AIDS 2004;
15: 1-6.

2. Shelton JD, Halperin DT, Nantulya V, Potts M, Gayle HD, Holmes
KK. Partner reduction is crucial for balanced “ABC” approach to HIV
prevention. BM J 2004; 328: 891-893.

3. Brewer DD, Brody S, Drucker E, et al. Mounting anomalies in the
epidemiology of AIDS in Africa: cry the beloved paradigm. Int J STD AIDS
2003; 14: 144-147.

Competing interests:
None declared

Competing interests: No competing interests

22 April 2004
John J Potterat
Independent consultant
Colorado Springs CO USA 80910