Campaign 'could cut new transmissions by 45%' and infection cycle would be broken, say Swazi officials
Leading scientists fighting the world's worst Aids epidemic have called on African leaders to head a month-long sexual abstinence campaign, saying it would substantially reduce new infections.
Epidemiologists Alan Whiteside and Justin Parkhurst cite evidence that a newly infected person is most likely to transmit HIV in the month after being exposed to it. An abstinence campaign could cut new infections by up to 45%, they say – a huge step in countries such as South Africa,Zimbabwe and Swaziland.
Whiteside's research with Parkhurst, of the London School of Hygiene and Tropical Medicine, focused on religious groups, such as Muslims who abstain from sex during Ramadan, and Zimbabwe's Marange Apostolic sect, which bans sex during Passover.
According to UNAids, predominantly Muslim countries such as Pakistan, Bangladesh and Indonesia have an HIV prevalence rate of 0.2%. The low rate has previously been attributed to the universal practice of male circumcision. But Whiteside argues that practising Muslim men are also protected from HIV by the ban on sex during the daylight hours of Ramadan, as well as strict teachings on alcohol use, homosexuality and extra-marital sex.
Predominantly Christian South Africa has 18.1% (5.7 million people) living with Aids. Zimbabwe has a similar proportion but members of the Marange sect have lower rates than the surrounding population. Swaziland, a small kingdom wedged between South Africa and Mozambique, has the highest proportion of infections in the world, at 26.1%.
Whiteside, of the University of KwaZulu-Natal, said: "This kind of initiative could provide hyper-endemic countries with a one-off, short-term adaptation that is cost-effective, easy to monitor and does not create additional stigma".
Whiteside said a month-long pledge to use a condom could also be effective. "The main thing is to agree on a bounded period in which the entire population would live by the same rule," he said.
In Swaziland, the idea was welcomed by the government agency in charge of Aids prevention. "We see this kind of initiative as a way of breaking the cycle. We think a good month to do it would be during the southern African spring, in October or November," said Derek von Wissell, director of Swaziland's National Emergency Response Council on HIV/Aids.
He rejected suggestions that abstinence would be perceived as moralistic or be hijacked by churches. Whiteside insists that a month-long campaign in his country, South Africa, is realistic. "We have this idea that we are going to put everyone on treatment. That is actually pretty fanciful. A month of abstinence or condom use is far less difficult to achieve".
