According to the UNAIDS report issued in June at the 2008 High-Level Meeting on AIDS, sub-Saharan Africa is home to 68 percent of all adults living with HIV. At that meeting, there was evidence of a new determination to fight the pandemic, as several African presidents vowed to do more.

Uganda and Senegal are among countries that have made progress against HIV/AIDS. But while the UN report noted a decline in the number of Zimbabweans living with AIDS, this is the result of many ailing persons dying without access to medication. The country’s ongoing political crisis, with its threats of violence and intimidation, has led many health care professionals to flee, said Farai Mahaso of the AIDS organization Batanai.

“A lot of good personnel leave to go to rich countries,” said Mahaso. “We train people, then they leave. I feel the government could do a lot more to help.”

“More than 1.3 million people are living with HIV, and more than 23,000 people are dying every week [in Zimbabwe],” Mahaso said. But Batanai is not waiting on action by the government: Instead, it has formed international partnerships and is using funding from the United States and other countries to open centers around the country offering counseling and medical supplies.

“Our data is starting to generate support for the idea that treatment, as well as being a benefit to patients, can also be effective in preventing AIDS cases in the future,” said Dr. Julio Montaner, a study coauthor.

The researchers developed a mathematical model to study the effect, over a 25-year period, of expanding access to highly active antiretroviral therapy in British Columbia. Although the province provides free HIV drugs, various challenges associated with treatment are blamed for the fact that just half the HIV patients there access HAART.

According to the study, expanding treatment to 75 percent of HIV-positive patients would cut the province’s number of annual new infections by 30 percent. Further extending treatment to 90 percent and 100 percent of patients would lower the number of future AIDS cases by 50 percent and 60 percent, respectively, the study says.

Montaner and colleagues have long been advocates of expanding HIV treatment as a means to reduce onward transmission because the drugs dramatically reduce patients’ viral loads, meaning they are much less infectious. The new model, he said, backs up this theory. “Bottom line, we showed that no matter how you configure it, the more people you treat, the more infections you prevent,” he said.

Montaner called for greater efforts to seek out patients and encourage them to enter treatment. “These results provide powerful additional motivation to accelerate the roll-out of HAART programs aggressively targeting those in medical need, both for their own benefit and as a means of decreasing new HIV infections,” the researchers concluded.

The full report, “Expanded Access to Highly Active Antiretroviral Therapy: A Potentially Powerful Strategy to Curb the Growth of the HIV Epidemic,” was published in the Journal of Infectious Diseases (2008;198(1):59-67).

“India has managed to slow down the epidemic in some states with more decisive planning,” said Denis Broun, UNAIDS’s India chief. “We have really worked a lot in mobilizing politicians and they have been able to visit around the country and understand the realities of AIDS and interact with people.”

“Cases are dropping in Tamil Nadu and it has been successful in Maharastra,” said Broun. “We are sure we are going to see success in Andhra Pradesh before a year.”

India has the world’s third-largest HIV/AIDS caseload and accounts for approximately half of Asia’s estimated 5 million people living with HIV.

While the country has had successes, the report warned that ignorance about HIV/AIDS and how to prevent it persists, especially among drug users and women in rural areas. Besides a lack of condom awareness, another challenge is sex education. A study among young brides in northern Uttar Pradesh state found that 71 percent knew nothing about how sex happens and 83 percent did not know about pregnancy.

According to the University of Miami’s Bryan Page, who chairs the anthropology department, teens today see and hear more about sex than in the past, through media, sex education, and even pornography. Teens are turning to oral sex to avoid pregnancy, he said. “Kids with a little high school health education know what’s going on in their own bodies, so to engage in oral sex would not be perceived as any risk,” he added.

“I know you can still pass on STDs, but there’s less of a chance, and no chance of getting pregnant,” said a Boca Raton boy, 14.

William Sydnor, who helps create the health curriculum for Broward County schools, said there has been a definite shift in values. Many teens “find oral sex is less intimate than kissing; they see it as less threatening behavior [than intercourse], so it’s more casually engaged in.” As a result, the county’s curriculum now discusses oral sex starting in seventh grade, he said.

Daniel Treiser, an associate rabbi at Plantation’s Temple Kol Ami Emanu-El, said his school’s curriculum focuses on sexual ethics. “I don’t tell kids‘Don’t perform oral sex,’ ‘Don’t have sex,’ because they’re not going to listen to that,” he said.

“I will say to them there are emotions involved, every physical act has an emotional counterpart, and they need to be as developed emotionally as they are physically before they start,” said Treiser.