12th World AIDS Conference
  
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...bridging the gap

LAST UPDATE: Friday , 03 July, 1998 00:20 GMT             AFRICAN STD                             ...all the news, as it happens
Lessons from African STD trials noted by US researchers
 

"There is little doubt that STDs are co-factors in HIV infection," said Marie Laga, of the Institute for Tropical Medicine in Antwerp, at yesterday's session on STD/HIV interaction. "But to what extent STD control will reduce HIV infection is a more complex question."

Results presented at the session suggest it may depend on the method of STD control. "It probably makes more sense to emphasise STD control for HIV prevention in those populations who already have STDs," Laga told The Bridge.

Maria Wawer presented data from the Rakai project in Uganda, in which treatment against STDs was administered by travelling teams to all persons in a cohort at ten-month intervals. Despite reductions in STDs relative to a control group who weren't treated for STDs, there was no difference in HIV incidence between the two groups.

Calculations presented by Ron Gray of the Rakai project showed that treating STDs could have reduced HIV incidence by at most 15%, a change not detectable by the trial. "Most HIV transmission [in this population] probably occurs irrespective of STD co-factors," he said, which is characteristic of a mature epidemic with a high HIV rate.

The value of intervening earlier in the evolution of an HIV epidemic is underscored by results from the Mwanza project reported three years ago. STD treatment decreased incidence of new HIV cases by about 40%. That initiative not only provided treatment but took a holistic approach, setting up STD referral centres, training health care workers in the syndromic approach, supplying STD drugs, providing supervisory visits and promoting clinic attendance.

William Kassler of the US Centers for Disease Control and Prevention favours the Mwanza approach. He noted that many American STD clinics lack capacity, staff and resources. He suggests the US should pay attention to Mwanza and improve these services in order to reduce the incidence of HIV in certain populations.

 

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this story can also be found in The Bridge, the onsite print newspaper


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