Efficacy evidences in prevention of HIV infection in developing countries. A critical appraisal from population-based studies

For generalised HIV/AIDS sub-Saharan African epidemics emphasis has been placed on the three established pillars of HIV prevention: condom promotion and distribution, Voluntary Counselling and Testing (VCT) and treatment of other sexually transmitted infections (STIs). Experiences in several countries support the positive results of Ugandan prevention politics called Abstinence, Be faithful, Condom (ABC), based on Primary Behaviour Change (PBC). Polemics tending to label this approach as “confessional based” have been recently intensified after Pope Benedict XVI recalled how the sole use of condoms cannot be considered the solution for HIV/AIDS in Africa. An honest and scientific approach to the dramatic reality of HIV/AIDS in Africa may yet require a reconsideration of the Western positions towards HIV prevention, accepting the potential challenge of a multifaceted strategy that uses all valid approaches, with particular regard to PBC: the elusive goal of vaccine, the simplistic trust in condoms, or acritical enthusiasm in drugs (either as therapy, postexposure or preventive treatment), mathematical modelling. All these are pieces of a complex puzzle. Synergy between treatment and prevention needs to be implemented in a realistic way, never forgetting that behaviour change is a process, not an event, involving human freedom and will. The need of a really participating community, with a prevention coming from below to the top and not from external over-imposing criteria, is also mandatory.