Expert Warns of Ominous Signs in AIDS Fight

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LOS ANGELES -- The number of Americans diagnosed with AIDS is now approaching the 1 million mark, with more than a half-million deaths since the epidemic began and 17,000 more people dying of the disease each year, Dr. Harold Jaffe said during a plenary session at the 14th Conference on Retroviruses and Opportunistic Infections.

That mortality--58 per million--is "twice as high as any country in the European Union and 10 times as high as in the United Kingdom," said Dr. Jaffe, former director of HIV prevention for the Centers for Disease Control and Prevention and current head of the department of public health at Oxford University, England.

A troubling jump in incidence in 2005, the latest year for which data are available, compounded by signs of risky behavioral trends in gay men, points to the critical need for community leadership, personal responsibility, and support of preventive efforts proven to work, he said.

"The need for treatment is critical, but I agree with my colleague Dr. Kevin De Cock [WHO director of HIV/AIDS] that we are not going to be able to treat our way out of this epidemic.

"I guess it seems obvious that we should be implementing what works, evaluating what might work, and stop trying to do what doesn't work," added Dr. Jaffe, who singled out federal funding for abstinence-only education as an example of a strategy based on beliefs rather than science.

A "very comprehensive" study in press in the Cochrane Review, for example, reviewed eight published randomized controlled trials of abstinence-only programs, compared with standard sex education or safe-sex programs, involving 13,191 American youths.

With a median follow-up of 12 months, none of the abstinence-only programs demonstrated a significant decline in self-reported sexual activity or any biological outcome such as pregnancy or diagnosis with a sexually transmitted disease (STD), compared with the other approaches, said Dr. Jaffe at the conference, sponsored by the Foundation for Retrovirology and Human Health.

A recent University of Pennsylvania study of 662 African American children (median age, 12 years) did show significantly less sexual activity among those receiving abstinence-only education, compared with those exposed to other interventions. …