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Twenty-Five Years of HIV: Lessons for Low Prevalence Scenarios

The Journal of Acquired Immune Deficiency Syndromes has published an academic paper exploring the "biosocial" aspects of HIV, with a particular focus on biomedical and behavioral HIV prevention. The paper builds on findings from the international workshop "Gender and HIV: Policy Lessons for Low Prevalence Scenarios," sponsored by UCLA's global health program, with support from the Ford Foundation, and in partnership with Columbia University. The foundation is committed to working with local partners to combat HIV/AIDS and to ensure we explore, evaluate and address the social, cultural and political factors shaping marginalized communities at risk.

Published by the JAIDS: Journal of Acquired Immune Deficiency Syndromes: July 2009, Volume 51, Issue 3

By Sharif Sawires, M.A.; Nina Birnbaum, M.D.; Laith Abu-Raddad, Ph.D.; Greg Szekeres, B.A.; and Jacob Gayle, Ph.D.

In 1981, the peculiar diagnoses of Pneumocystis carinii (Pneumocystis jiroveci) pneumonia and Kaposi sarcoma among several gay men in San Francisco, Los Angeles, and New York were soon linked to HIV infection and subsequently to AIDS. Over the next 25 years, international responses cycled through a number of compartmentalized strategies of identification, treatment, or prevention. Each domain was in part driven by the underlying urgency to develop efficient responses to generalized epidemics or preventing the rapid expansion of concentrated epidemics and their diffusion to new populations. These approaches coupled with the need to garner international support from governments and civil society lent them to a "crisis" paradigm where the threat of rapid epidemic growth of HIV/AIDS was presented as the consequence of inaction. Although the crisis paradigm was instrumental in mounting an unparalleled global public health response in the first quarter century of the epidemic, the limits of this strategy have become evident, particularly in low prevalence scenarios.

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