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<DIV><B>Estimados Todos,</B></DIV>
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<DIV><STRONG>Este documento fue traducido por Antonio de Moya y entregado el dia de ayer en el evento <A href="http://www.impactaperu.org/cursovih2004/">http://www.impactaperu.org/cursovih2004/</A></STRONG></DIV>
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<DIV><B>The time has come for common ground on preventing sexual transmission of HIV</B> </DIV>
<DIV><A href="http://www.thelancet.com/">http://www.thelancet.com/</A></DIV></TD></TR></TBODY></TABLE>
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<P></P>The HIV/AIDS pandemic is an urgent health and growing humanitarian crisis, especially in the high-prevalence regions of sub-Saharan Africa where most new infections continue to occur. On World AIDS Day (Dec 1), two decades after the discovery of the virus that causes AIDS and after many millions of deaths, we believe it is critical to reach consensus on a sound public-health approach to the prevention of sexually transmitted HIV. Although transmission from injecting drug use is a serious and increasing problem in some regions, here we focus on sexual transmission, which continues to account for most infections globally. Sexual behaviour is influenced by many factors not always under an individual's control, including gender norms and social and economic conditions. However, the public-health community has an obligation to offer people the most accurate information available on how to avoid HIV, and to encourage changes in societal norms to reduce the spread of the viru
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<P></P>Although prevention should encompass multiple integrated elements, including links to expanded treatment access, changing or maintaining of behaviours aimed at risk avoidance and risk reduction must remain the cornerstone of HIV prevention. We call for an end to polarising debate and urge the international community to unite around an inclusive evidence-based approach to slow the spread of sexually transmitted HIV, on the basis of the following key principles.
<P></P>First, programmatic approaches must be locally endorsed, relevant to the indigenous social and cultural context,<SUP>1</SUP> and respectful of human rights.<SUP>2</SUP> Interventions must also be epidemiologically grounded, addressing the main sources of new infections<SUP>3</SUP>--whether concentrated in high-risk settings such as commercial sex<SUP>1,3-5</SUP> or spread widely through multiple concurrent partnerships in the general population.<SUP>5-7</SUP>
<P></P><STRONG>Second, the ABC (Abstain, Be faithful/reduce partners, use Condoms) approach can play an important role in reducing the prevalence of HIV in a generalised epidemic, as occurred in Uganda.<SUP>8-13</SUP> All three elements of this approach are essential to reducing HIV incidence, although the emphasis placed on individual elements needs to vary according to the target population. Although the overall programmatic mix should include an appropriate balance of A, B, and C interventions, it is not essential that every organisation promote all three elements: each can focus on the part(s) they are most comfortable supporting. However, all people should have accurate and complete information about different prevention options, including all three elements of the ABC approach.</STRONG>
<P></P>Thus, when targeting young people, for those who have not started sexual activity the first priority should be to encourage abstinence or delay of sexual onset, hence emphasising risk avoidance as the best way to prevent HIV and other sexually transmitted infections as well as unwanted pregnancy.<SUP>14</SUP> After sexual debut, returning to abstinence or being mutually faithful with an uninfected partner are the most effective ways of avoiding infection. For those young people who are sexually active, correct and consistent condom use should be supported. Young people and others should be informed that correct and consistent condom use lowers the risk of HIV (by about 80-90% for reported "always use"<SUP>13,15</SUP>) and of various sexually transmitted infections and pregnancy, and they should be cautioned about the consequences of inconsistent use. Prevention programmes for young people in and out of school should be expanded, and parents should be supported in commu
nicating
their values and expectations about sexual behaviour. </DIV>
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<DIV class=jourcontentblack>Saludos</DIV>
<DIV class=jourcontentblack>LM</DIV></DIV><BR><BR>Lady Murrugarra
Oficina : 511-4823910, 4823903 anexo 15
Celular : 511-9654-9748
RPM. 939178
Msn: lmurrugarra@hotmail.com<p>
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