BEHAVIORAL APPROACHES OVERLOOKED IN AIDS FIGHT

MEXICO CITY -- While the world awaits findings from new AIDS
prevention trials, millions of people are becoming infected because
governments are overlooking studies showing that behavior modification
works, AIDS experts said Tuesday.

Among the behavior modifications the experts cited: promoting safer
sex through delayed intercourse and the use of condoms, decreasing
drug abuse, providing access to needle exchange programs and promoting
male circumcision.

But none of the measures alone offer a simple solution to preventing
infection with H.I.V., the virus that causes AIDS, the experts said in
a number of reports and news conferences at the 17th International
AIDS Conference here.

The experts said characteristics of the global epidemic varied greatly
among and within countries, most of which were not focusing prevention
resources where their epidemics were concentrated. Combining these
measures and delivering them on a wider scale is crucial to reversing
the global H.I.V. epidemic, they said.

Health workers have had initial successes in providing antiretroviral
drugs to treat an estimated three million people worldwide. But tens
of millions more people need the drugs, and additional millions are
now becoming infected.

The world cannot treat its way out of the AIDS epidemic, many experts
have long said, and a scientific debate exists over the extent to
which antiretroviral therapy can reduce transmission of the virus. A
pressing need exists to combine H.I.V. prevention and treatment
efforts, experts said Tuesday.

Researchers involved in each field "need to get married today," said
Dr. Myron S. Cohen of the University of North Carolina. "We need to be
one community."

A 50-member panel known as the Global H.I.V. Prevention Working Group,
which is supported by the Bill & Melinda Gates Foundation, released a
report saying that prevention efforts must address a number of
perception problems.

One is misplaced pessimism about the effectiveness of H.I.V.
prevention strategies. A second is confusing the difficulty in
changing human behavior with an inability to do so. A third is a
misperception that because it is inherently difficult to measure
prevention success, those efforts have no impact, the report said.

In the wake of three scientifically controlled studies showing that
circumcising adult men helps prevent H.I.V. infection, some progress
has been made in offering the procedure. But no country has succeeded
in fully educating its public about the benefits of circumcision,
according to PSI, a nonprofit organization in Washington.

Dr. Adeeba Kamarulzaman of Malaysia said that outside Africa, about 30
percent of H.I.V. infections were among intravenous drug users. But
because of stigma and a lack of resources, the world is failing to
provide measures like methadone and needle sharing that can help such
people.

Meanwhile, The Lancet, a medical journal published in London, released
a series of papers on H.I.V. prevention to be published on Saturday.

"Behavioral strategies need to become more sophisticated," and "that
task is not easy," Thomas J. Coates of the University of California at
Los Angeles wrote in one article. In expanding prevention programs, he
said, governments must be sure that they put in place "the right programs."

Dr. Jorge Saavedra, who directs Mexico's H.I.V.-AIDS program, said
that national AIDS responses needed to involve more gay and bisexual
men in planning ways to reach high-risk individuals. If political
leaders do not follow the epidemiological and scientific evidence and
direct efforts where they are most needed, "we will lose the fight
against H.I.V.," he said.