HIV Prevention Requires Combining Multiple Methods

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Main Category: HIV / AIDS
Also Included In: Infectious Diseases / Bacteria / Viruses;  Immune System / Vaccines
Article Date: 07 Aug 2008 - 0:00 PDT

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Researchers argue that a combination of behavioral, medical, and structural approaches grounded on solid evidence, known as combination prevention, is the best hope for successfully preventing HIV in the future. In the first of six papers in The Lancet Series on HIV prevention, Professor Michael Merson (Duke Global Health Institute, Duke University, Durham, NC, USA), Jeffrey O'Malley (HIV/AIDS Practice, UN Development Program, New York, USA) and colleagues insist that the mistakes of the mid-1990s cannot be repeated.

The authors outline the brief history of the HIV/AIDS pandemic. In 1981, the Centers for Disease Control and Prevention, USA, published the first confirmed reports of AIDS. In recent years, researchers have developed antiretroviral drug (ARV) treatment, and donor programs are discussed at high level UN meetings. Merson and O'Malley also detail the difficulties seen worldwide in accepting and acknowledging the disease as well as the inconsistent and poor responses of many governments in the earlier years. For example, in the mid-1990s the pandemic expanded substantially as many countries reduced political and financial support for HIV/AIDS issues. "Early prevention successes evolved from collective responses generated by people living with HIV/AIDS and community groups, and confronted the stigma, discrimination, and denial associated with the disease. A global response, involving social factors such as sexual behaviour, injecting drug use, and gender inequalities, is needed to fully address the HIV/AIDS pandemic," write the authors.

Analyzing data on country-specific HIV cases and incidence, the researchers maintain that current global prevention efforts are still unacceptable - fewer than 10% of at-risk individuals in the world receive important prevention services. "Expansion of these services could avert more than half the HIV infections projected to occur by 2015 and save $24 billion in treatment costs," they write. If 70% of males are circumcised, according to one study, about 700,000 cases of HIV could be prevented in sub-Saharan Africa up to 2015. Although the last five years has seen a tenfold increase in the number of people receiving ARV therapy, there are five new HIV infections for every two patients on ARVs in 2007.

The authors say that resources are not available to reach the goals set out in the 2006 UN World Summit - that is, a US$42.2 billion package for HIV prevention and care leading to almost universal coverage by 2010. "Successful prevention requires knowledge of the nature of the epidemic in individual countries, as well as community and country contexts," they write. More parties are recommending that HIV prevention be combined with an overall strengthening of the health system in every affected country. The researchers write: "We need not only more managers, public-health experts, physicians, and nurses, but also a new cadre of community workers whose education is rooted in community development, gender equity, human rights, and public health, and who will be equally powerful in the promotion of hygiene, sanitation and use of bednets as they are in the generation of a community response to HIV prevention."

"We now require an urgent and revitalised global movement for HIV prevention that supports a combination of behavioural, structural, and biomedical approaches and is based on scientifically derived evidence and the wisdom and ownership of communities...With millions of people on treatment and the incidence of HIV infection falling in places, many involved in public health and public policy are calling for a shift of attention from HIV to other diseases...HIV prevention must remain one of the world's top health and development priorities - now and for a generation to come. The mistakes of the mid-1990s, when HIV/AIDS slipped down the political agenda and the pandemic greatly expanded, must not be repeated," conclude the authors.

The history and challenge of HIV prevention
Jeffrey O'Malley et al.
The Lancet (2008).
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Written by: Peter M Crosta
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