Impact on HIV - Expanding the Response - Volume 1 - Nº2 - September 1999 - 04 - Impact on HIV: Opinion: After Rakai: What Next?

Despite seemingly contradictory results from two major studies, STI prevention and control remains one of the most effective ways to reduce HIV transmission in many populations at risk and a critical public health priority.. . In August 1995, the results of a landmark study demonstrated that community-based treatment of symptomatic sexually transmitted infections (STIs) could dramatically reduce HIV incidence.1 Strong biological and epidemiological evidence had long pointed to a critical role for STI control in HIV prevention.2 But the magnitude of the impact shown in this randomized controlled trial in the Mwanza region of Tanzania -- a 40 percent reduction in new HIV cases -- was striking.. . Less than three years later, the findings from a second community-based randomized trial of the impact of STI treatment on HIV incidence delivered yet another surprise. This study, which offered treatment for common curable STIs to all adults in ten communities in Uganda’s Rakai district, found that the intervention had reduced some STIs, but had had no impact on the rate of new HIV infections.3. . These apparently contradictory results have understandably left many people confused about the role of STI control in HIV prevention. Many assumed that one of the studies must be wrong. Others argued that discrepancies ...

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