be used more generally because the risks from transplants are high.
programmes (injecting drug users can exchange used needles for new ones, in order to discourage sharing and re-use); and sexual abstinence. The pharmaceutical side of prevention includes: condoms; vaccines which would protect uninfected individuals from contracting HIV (although no effective vaccine has yet been produced); and finally circumcision (removal of the foreskin from the human penis). A 2009 study done on sexually active men in Africa found that circumcision reduces the infection rate of HIV among heterosexual men by 38–66% over a period of 24 months. 31 The WHO recommends considering circumcision as part of a comprehensive HIV programme in areas with high endemic rates of HIV, such as sub- Saharan Africa, where studies have concluded it is cost-effective against HIV. The apparent success with the Boston patients has caused a surge in optimism that a cure could be imminent. Nevertheless, 30 yearsÊ experience of struggle against HIV means we must accept that a viable cure for most HIV patients may still be a long way off. With an estimated thirty-three million people 32 currently living with HIV, for the foreseeable future it seems we cannot give up on a multi-faceted approach, combining education, diagnosis, treatment and prevention. 31 [Wikipedia, Circumcision , 2013] 32 [World Health Organization, Fast Facts on HIV , 2013]
Perhaps the Berlin and Boston cases should not be viewed too optimistically. Their ÂcuresÊ have come at a high price – intensive chemotherapy and life-long immuno- suppressants and still a significantly lower life expectancy. Alternatively, if we simply improved our HIV testing strategies and detected HIV earlier, we could keep patients healthy and improve their chances. One in four of those in the UK who are living with HIV are not aware they are infected. 29 In developing countries in particular, the problem of treating HIV is compounded by the prejudice and abuse often directed at sufferers. The consequences are wide- ranging, including being shunned by family and community, poor treatment in healthcare and psychological damage, leading to negative attitudes towards HIV testing and treatment. Also, despite reductions in the price of drugs, treatment reminds expensive to buy and to administer. Some activists are worried that the focus on treatment is detracting from prevention. 30 HIV prevention encompasses social as well as pharmaceutical strategies: requiring people to change their behaviour in order to gain protection from HIV. The social side includes sex education; needle exchange 29 [Lipkin, Professor W. I., 21 st Century Challenges , (Lecture). 2011] 30 [de Waal, AIDS and Power: why there is no political crisis – yet , 2006] HIV prevention
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