It sounds too good to be true, and it may prove to be so in the real world, but researchers at the World Health Organization have come up with a suggestion to drastically reduce the transmission of AIDS and virtually halt the widening epidemic in Africa within a decade.

On this 20th anniversary of World AIDS Day, after repeated failures to create an effective vaccine, the provocative “thought experiment” at least lifted our spirits.

The analysts developed a mathematical model to predict what would happen if most adults and adolescents were tested every year for the virus that causes AIDS and those who tested positive were immediately treated with antiretroviral drugs instead of waiting until their immune systems were depressed, as is now policy.


The results, described last week in The Lancet, a British medical journal, were remarkable. Transmission of the virus from infected individuals to others could be driven so low as to be nearly eliminated within a decade, largely because the drugs would drastically reduce the amount of virus in their blood and genital secretions.

Whether this could work in practice is problematic. It is not clear how one could persuade people who are not feeling sick to get tested every year and to undergo long-term drug therapy if they test positive. The cost of testing and treating so many people would be high. And the drugs can be toxic with prolonged use. Their effectiveness can be undermined if resistant strains of the virus develop.

But the aspiration is compelling. In the long run, the researchers estimate, this approach could actually be cheaper than the current practice of waiting to treat victims until their infection has reached an advanced stage. AIDS activists are cautiously optimistic that the endless battles over whether to emphasize treatment or prevention could be leapfrogged by a combined approach that used drug treatments to prevent transmission.

At the moment, nobody is recommending the new approach, but the W.
H.O. will convene a meeting to discuss its implications. If the resources can be found, it would be worth testing the theory in a suitable area.