Akl Helps Develop WHO Guidelines to Curb Spread of HIV
Elie A. Akl, MD, PhD
Published August 1, 2011 This content is archived.
Elie A. Akl, MD, PhD, recently served as guideline methodologist for the World Health Organization’s first global recommendations to decrease HIV/AIDS rates among men who have sex with men and transgender individuals.
A University at Buffalo assistant professor of medicine, family medicine and social and preventive medicine, Akl reviewed the WHO guidelines, making sure that they were based on the best evidence from peer-reviewed scientific data.
Rising HIV Rates Prompt Recommendations
WHO developed the guidelines to help public health agencies around the world—especially in low- and middle-income countries—establish programs for HIV treatment and prevention.
Published in June, they suggest ways to improve access to such services, particularly in countries where criminalization of same-sex relationships make people afraid to seek them out.
WHO drafted the guidelines in response to a resurgence of HIV among men who have sex with men in industrialized countries as well as in Africa, Asia, the Caribbean and Latin America.
(Epidemiologists and other public health professionals use the phrase “Men who have sex with men”—initialized as “MSM”—to identify potential disease risk among individuals regardless of how they identify themselves.)
MSM, Transgender Panelists Provide Perspective
As the project’s guideline methodologist, Akl assessed the medical evidence on HIV prevention and treatment using GRADE, a systematic health care review process that national and international organizations are increasingly adopting.
“The GRADE approach starts by defining the questions important to the guideline users," explains Akl, an expert in in evidence-based medicine and a member of the GRADE working group.
“It conducts systematic reviews of the literature to evaluate the scientific evidence for those questions and then develops recommendations, taking into account the values and preferences of the target population.”
The WHO guidelines panel included individuals from the global MSM and transgender community says Akl, noting that their participation was essential.
“We asked them about their values and preferences in relation to different interventions being considered.”
Agencies Can Withold Funds to Resistant Countries
The executive summary of the WHO guidelines notes that more than 75 countries criminalize same-gender sex. In most countries, transgender people lack legal recognition, which forces them to risk criminal sanctions if they reveal their sexual risks to a health care provider.
While the WHO guidelines can't force countries to change the way they provide health care, Akl says that global agencies such as the World Bank or PEPFAR (the U.S. President's Emergency Plan for AIDS Relief) can make funding contingent on countries adopting them.
Akl Also Reviewing Similar Guidelines for Sex Workers
Akl is the guideline methodologist for several other WHO projects, including the first global guidelines for HIV/AIDS treatment and prevention among sex workers, which will be issued in the next several months.
He is also involved with WHO efforts to retain health workers in underserved and rural areas and to scale up transformative medical and nursing education in the developing world.