Nov. 29, 2007 -- Ten HIV/AIDS myths perpetuate the worldwide AIDS epidemic, a
USAID researcher argues.
We've been fighting the AIDS pandemic for decades but still are losing
ground. Why? James D. Shelton, MD, MPH, science advisor at the U.S. Agency for
International Development, has a radical suggestion.
Before offering his suggestion, however, Shelton challenges 10 "myths" that
impede HIV prevention. It's a
controversial position -- one that irks Gordon Dickinson, MD, chief of
infectious diseases at the University of Miami and the Miami VA Medical
Shelton's provocative commentary, appearing in the Dec. 1 World AIDS Day
issue of The Lancet, focuses on the "generalized HIV epidemics" in
Africa. Dickinson's objections focus on how these comments might be
counterproductive in the U.S. and other developed nations.
It does not, Shelton argues, noting that only 8% of people whose
heterosexual partner carries HIV become infected each year.
"This low infectiousness in heterosexual relationships partly explains why
HIV has spared most of the world's populations," Shelton writes.
That may be true, Dickinson counters. But when a person is first infected
with HIV -- and still is negative on most HIV tests -- that person is
extremely infectious. This means that in certain circumstances HIV can spread
"Let's say you are a young adult and single and living on South Beach and
you go clubbing every weekend and are somewhat promiscuous," Dickinson tells
WebMD. "If you have an acute HIV infection, it will spread like wildfire. This
is not a conflagration that will cover a whole continent. But in individual
places, HIV spreads rapidly."
"Myth" 2: Sex Work Is the Problem
Relatively few men with multiple sexual partners pay for sex with a
prostitute, Shelton notes. In areas of Africa where HIV is widespread, men
often have financial arrangements with women who do not think of themselves as
prostitutes. But targeting prostitutes does not reach these women and will not
have a major impact on the epidemic.
"Myth" 3: Men Are the Problem
Shelton notes that in areas where HIV is widespread, women are just as
likely as men -- in some areas, more likely -- to be the sexual partner first
infected with HIV.
Kathleen Squires, MD, director of infectious diseases at Thomas Jefferson
University, Philadelphia, says the myth in the U.S. is that HIV is a disease of
"If you look at newly diagnosed HIV infections, the proportion among women
has steadily risen," Squires tells WebMD. "This clearly impedes diagnosis --
and prevention messages. Moreover, HIV disproportionately affects women of
color and women in disadvantaged populations."
"Myth" 4: Teens Are the Problem
If HIV prevention efforts emphasize preaching abstinence to teens, they won't have much effect on the epidemic,
Shelton suggests. He notes that people of all ages get and spread HIV -- and
that where HIV is epidemic, HIV becomes more common among women in their 20s