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Some scientists in South Africa are promoting a bold proposal that they say could halt the spread of HIV. Called “test and treat,” it would test everyone for HIV every year and would immediately put those who are infected on anti-retroviral drugs, as a way to prevent the further spread of the virus. But critics say the plan is unrealistic and could actually harm people who are already infected. The World’s Laura Lynch reports. (Photo: Laura Lynch)

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MARCO WERMAN: Scientists, activists, and philanthropists will gather in Vienna starting this weekend to take stock of the global AIDS epidemic. The Eighteenth International AIDS Conference comes at a time when more people than ever have access to treatment for HIV. But each year close to three million people become infected. Some scientists believe there is a way to halt those infections using drugs that are available today, but in a different way. They want to test the concept in the country with the largest burden of disease, South Africa. But critics argue the strategy could harm those who are already infected. The World’s Laura Lynch reports.

LAURA LYNCH:  On this dusty patch of land in downtown Cape Town, South Africa’s struggle to treat its HIV epidemic plays out. Parked between a church and a busy road, a trailer has set up business for the day. It’s here to test people for HIV, the virus that causes AIDS. The trailer is called the Tutu tester, a mobile clinic named for Archbishop Desmond Tutu, part of his foundation that’s dedicated to the fight against HIV. Today, the health workers are testing a group of rough and ready laborers who have been enticed to show up by the offer of free groceries.

FEMALE SPEAKER:  Your fingers are thick. Working too hard.

LYNCH: A nurse pricks a man’s finger for a blood sample. The result is ready within minutes.

FEMALE SPEAKER: Your HIV result is negative.

LYNCH: If the result had been positive, he would have been given counseling and a further test to determine whether his immune system was getting weak. And if it was too weak, he would have been given antiretroviral drugs, or ARVs. This is how African countries plug away at the epidemic, case by case, prescribing the drugs only when a patient’s health has deteriorated. John Hargrove is the director of the South African Centre for Epidemiological Modeling and Analysis. He thinks the strategy isn’t working at least as far as prevention is concerned.

JOHN HARGROVE: Almost everything that we’ve tried as interventions against HIV have failed to reduce the rate at which new cases are happening, particularly in Southern Africa. We need to think out of the box. We need something new.

LYNCH: So he and his colleagues are proposing a new strategy, known as test and treat. The idea is this. Test more aggressively. Test everyone, every year. And when people test positive treat them right away. That’s because even if they show no signs of illness, those with HIV can still infect others. Giving these people antiretroviral drugs early could reduce their chances of spreading the virus. In other words, put patients on treatment not to improve their health, but to protect others from catching the virus.

HARGROVE: If you get people onto antiretroviral’s quickly, the assumption is that the person would have a very low infectivity to other people.

LYNCH: Last year, Hargrove and his colleagues made a bold claim. They produced a mathematical model of the strategy suggesting that, if implemented fully, it could halt the transmission of HIV in Africa in just five years. Hargrove admits that at this stage it’s really just a theory. They want to test it. But for that, they need to find a community willing to take on the challenge, in spite of the stigma still attached to HIV and AIDS in much of Africa.

HARGROVE:  Unless the entire community actually says let’s actually get everybody tested and get those people who are positive on treatment, then it won’t work.

LYNCH: Hargrove also knows he needs to build broad based support and there are already indications it won’t be easy.

CATHERINE TOMLINSON: There really isn’t evidence that it will work. At this point, there’s more evidence that it could be potentially harmful to the individuals.

LYNCH: That’s Catherine Tomlinson. She’s a senior researcher with the Treatment Action Campaign which defends the rights of people with HIV and AIDS in South Africa. Tomlinson points out that antiretroviral drugs can have severe side effects, so why would people with HIV go on the drugs before they need them? What’s more, she says, if people start treatment early, they could develop drug resistance.

TOMLINSON: By the time they get to the point that they need treatment for their own health, there’ll be a risk that that treatment, that they were started on no longer works. If they aren’t then able to access a different treatment that does work, then they’ll put their own lives at risk.

LYNCH: Tomlinson says the test and treat strategy stands to sacrifice the interests of individual patients even if it helps the community overall. And there’s a more practical question. How to pay for it all. AIDS drugs are expensive and already in short supply. Expanding drug treatment to everyone who is HIV positive would require a lot more money from already stretched international donors. But John Hargrove says in the long term, the models show it’s worth the cost.

HARGROVE: You will spend the same amount of money by 2050 whichever route you take. The difference will be with our scenario in 2050 there will be no more epidemic. If we continue to do what we’re doing right now, unless there is a massive change in people’s behavior, we’ll still have the same epidemic in 2050. Nobody wants that.

LYNCH: For now, in South Africa testing efforts remain low key and far from widespread even though the need seems great. The counselors at the mobile clinic have to break the bad news of positive tests to as many as a dozen people every time they set up shop. On this day, fatigue and frustration seem to have taken a toll on one nurse.

FEMALE SPEAKER:  I’ve seen enough men for the whole day. Fed up now.

LYNCH: The sick, the infected, health care workers, everyone would love to see a solution. A way to finally stop the spread of HIV. John Hargrove hopes to pilot the test and treat strategy in South Africa by the beginning of next year. And the US government is helping to run trials in Washington and the Bronx in the coming months. Still it will likely be years before anyone knows whether this could be the beginning of the end of HIV. For The World, I’m Laura Lynch, Cape Town, South Africa.

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