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There Are Proven Ways to Fight HIV. Telling People Not to Have Sex Isn’t One

Sometimes the truth is obvious.
Former US President George W. Bush watching a skit on abstinence during a visit to the 'Lycee de Kigali', a school, in Kigali on February 19, 2008. Image: Jim Watson/AFP

Here's some news that will shock you: Studies are showing that fighting HIV is going to cost money, and spending that money on telling people not to have sex is a basically like throwing it into the toilet.

Over the last five years, transmissions rates and new cases of HIV have dropped in the US, according to a new study published in AIDS and Behavior. In 2015, the number of new cases of HIV infection was down 11 percent over 2010. Transmission rates—that's a measure of transmissions in relation to the current number of HIV-positive people—had fallen 17 percent. That's great news, but it fell short of the goals President Obama laid out in his National HIV/AIDS Strategy back in 2010, which hoped to see transmission rates fall by 30 percent, and new cases to drop by 25 percent.

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The study shows that, while the strategies laid out—which included things like developing cheaper treatments and creating simpler systems to connect patients with health care—were effective, we flat out didn't invest enough money into seeing them through

"We got part of the way there, that should be highlighted, but at the same time we only got about halfway to the finish line," David Holtgrave, chair of the Bloomberg School's department of health, behavior and society and lead author of the study, told me over the phone. "The National AIDS Strategy is a terrific document and is really very visionary, but it doesn't address the costs necessary to achieve the goals. As a nation, we didn't quite make the investment that was necessary to scale up programs to the level that was needed."

But the limited success of the national strategy highlights a key component in fighting HIV infection: investing in education, healthcare, and prevention strategies works, and the more the better. Telling people to just not have sex doesn't.

That was the US's strategy for fighting HIV in sub-Saharan Africa, part of a nine-year, $1.4 billion program first introduced by President Bush. Bush's overall strategy included other efforts, but required that at least a third of the program funding be used to teach abstinence. Education campaigns in 14 countries promoted waiting until marriage to have sex as a strategy for reducing HIV transmission and new infection cases. It didn't work, according to a study published in Health Affairs this month.

The study looked at five higher-risk behaviors associated with HIV transmission: number of sexual partners in the last year (both men and women), age of first intercourse (both men and women), and teen pregnancy rates. The study authors compared these rates from 1998-2013 in 22 sub-Saharan African nations, including the areas where the abstinence campaign was introduced. They found no link between the abstinence education and a reduction in any of the risk factors.

"Overall we were not able to detect any population-level benefit from this program," Nathan Lo, a Stanford MD/PhD student and lead author of the study, said in a press release. "We believe funding should be considered for programs that have a stronger evidence basis."

Fighting HIV is a complicated endeavor, to say the least. It's not as simple as handing out condoms. Medically, we've made tremendous gains. There are treatments that help HIV-positive individuals reduce their viral load and live healthier lives while at the same time reducing the risk of transmission, so prevention and treatment go hand-in-hand.

But Holtgrave noted there are a whole host of factors that might prevent someone from getting the treatment they need, which range from cost, to stigma, to homelessness. That's why a diverse strategy needs the funding to back it up, so we can invest in everything from awareness campaigns addressing stigma to building housing for homeless individuals so they can focus on their health. And if we're going to be spending billions of dollars to fight this plague, we might as well spend it on something that works.