The most effective way to contain the HIV epidemic in hard-hit South Africa is to treat residents of large cities at first, a latest U.S. research indicated.

Modeling HIV drug allocation strategies in 2004-2008 in KwaZulu-Natal, a populous province in South Africa near Durban, the researchers at the University of Califonia, Los Angeles, found that treating only Durban's urban residents but not treating rural residents would minimize the number of AIDS deaths and prevent the largest number of new infections in next few years.

The study was published in the Sept. 11 edition of the Proceedings of National Academy of Sciences.

Although this urban-first approach may appear the least ethical, since it neglects rural residents, the researchers argued it is the most successful model in terms of mortality reduction, infection prevention, and reducing transmitted resistance.

The researchers looked at three drug allocation strategies: one that would allocate antiretroviral drugs only to the city of Durban and two making them available in both urban and rural areas.

Of those, the city-only strategy would reduce infections by up to 46 percent, amounting to preventing additional 15,000 infections by 2008, compared with two other strategies, the researchers found.

This was the first time that city and village models had been used to evaluate the epidemiological impact of treatment strategies and of the consequences resulting from various drug allocation strategies, the researchers wrote.

The methodology and results in the paper can also be very easily applied to other developing regions with scarce drug availability, according to the study.

But major problems would emerge with that approach, said Sally Blower, senior author of the study and a professor at the University of California, Los Angeles.

Most important, she noted, this approach is against basic ethical principles guiding treatment equity and would lead to more urban/rural healthcare disparities than already exist.

"Unfortunately, you can't have the maximum impact on the epidemic and be ethical," said Blower.

"But it's obviously unlikely that this type of rational planning would or could occur. So it's much more likely that the actual drug allocation strategy will be determined by a mix of politics and feasibility."

Source: Xinhua