What is the best HIV prevention strategy for the Obama administration to fund with new PEPFAR money?
Well, my views here also upset a lot of my colleagues, but I’ve always said that we cannot treat our way out of this pandemic. A sound public health approach is always based on good prevention strategies. We can justify treatment with expensive anti-retroviral drugs on humanitarian grounds, but it’s hard to do on public health grounds. So I would advise Obama, the candidate I voted for, to put more emphasis on prevention, and to face up to the hard realities of the best evidence available to date, which shows that condom promotion, testing and counseling, curing the curable STDs, or any of the other interventions widely endorsed and considered “best practices” always funded have simply not worked in Africa. (It’s possible they may work in other regions, like condoms in Thailand, so it’s easy for me to be misquoted on something like this.) In a number of studies, these interventions have actually been shown to not work. The two interventions that work best in Africa are promotion of mon
