With leading donor countries emerging from economic crisis, development aid flows are under heavy pressure. As a result, governments, development agencies, civil society organizations, communities of people living with HIV, and other partners need the best evidence and knowledge available to extend their development dollars in pursuit of better results. The World Bank's Global HIV/AIDS Program and the Office of HIV/AIDS at USAID co-hosted a debate series on the constantly changing dynamics of HIV/AIDS and our collective response. The series began in May 2010 at the World Bank in Washington, D.C. and continued through the 2012 International Conference on AIDS. Thanks to the Global Development Learning Network's video conferencing and web-based technologies, country teams and partners in Africa and beyond took part in the Washington-based debate series. Typically, four to six experts in the field participated in the moderated debate, followed by a panel discussion and a session of questions and answers.
On Wednesday, May 19, 2010, the World Bank and the U.S. Agency for International Development (USAID) cohosted the first in a series of debates on emerging issues in the global response to HIV/AIDS. The purpose of the debate series is to provide governments, civil society organizations, and other partners with the best evidence and knowledge to ensure that development dollars go further in pursuit of better results, of particular importance in an era when development aid is under heavy pressure and the dynamics of the pandemic are constantly changing. The World Bank’s Global Development Learning Network video conferencing and webbased technologies allowed country teams in Africa and other partners from across the globe to participate in real time in the debate, which took place in Washington, DC.
The debate was based on the following proposition: “Behavior change in generalized epidemics has not reduced new HIV infections and is an unwise use of HIV prevention resources.” Given the scarcity of research evidence for behavioral prevention efforts, questions about these efforts are being asked with increased intensity. Do behavioral prevention efforts work? If they do work, what kinds of interventions work best? How many new infections could behavioral interventions avert?
Debate 3 focused on discordant couples and HIV transmission, and was based on the following proposition: Intracouple HIV transmission between couples in long-term stable partnerships drives a majority of HIV transmission and should receive the majority of HIV prevention funding. The debate was moderated by Karl Hofmann, President and CEO of Population Services International. Two panelists spoke in favor of the proposition: Dr. Elizabeth Marum, Senior Regional Advisor in HIV Prevention, Division of Global AIDS, Center for Global Health at the Centers for Disease Control and Prevention (CDC); and Dr. Susan Allen, Professor of Pathology and Laboratory Medicine at the School of Medicine, Emory University.
Debate 4 focused on the possible role of concurrent sexual partnerships in accelerating ongoing HIV transmission patterns. The debate was based on the following proposition: Concurrent sexual partnerships have been and remain a key driver of HIV epidemics in southern and eastern Africa, and interventions to this effect should receive the majority of prevention resources.
Emerging Issues in Today’s HIV Response: Debate 5—The Ethics of Material Incentives for HIV Prevention
Debate 5 focused on the ethics and effectiveness of using material incentives to prevent the further spread of HIV. The debate was based on the following proposition: Providing material incentives is an ethical and effective tool for HIV prevention and should be implemented.
Debate 6 discussed the proposition, “Countries should spend a majority of what is likely to be a flat or even declining HIV prevention budget on ‘treatment as prevention.’” The topic reflects critical questions arising from observational studies and a recent prospective clinical trial demonstrating the effectiveness of antiretroviral therapy (ART) for HIV prevention. Much of the debate centered on the dramatic findings of the recent HIV Prevention Trials Network (HPTN) 052 study of 1,763 HIV-serodiscordant couples in nine countries in Africa, Asia, and Latin America. The HPTN 052 study showed that early treatment—started at a CD4 count between 350 and 550 cells/mm3—reduced the risk of HIV transmission to an uninfected partner by at least 96 percent. This suggests that starting ART earlier than many treatment guidelines currently recommend could have significant impact on the spread of HIV.
The final debate, held at the World Bank, was also screened live at a satellite session at the International AIDS Conference and via live webcast and blog on the World Bank website in English, French, Spanish, and Arabic. Approximately 375 people attended the debate at the World Bank’s Preston Auditorium, over 60 people attended the International AIDS Conference satellite session, and nearly 1,000 people watched the webcast of the debate live and during the week after the conference.