HIV

Charity number: 1078268 * Company registration number: 3867526

---

---

---

---

---

---

AIDS Conference calls for combination prevention

Whether described as combination prevention or highly active HIV prevention the emphasis at the International AIDS Conference held in Mexico City has been on the need for multi pronged prevention programmes.  In a special session some of the world’s leading researches called for HIV prevention efforts to be redoubled in a manner equivalent to  the campaign to provide universal access to HIV treatment.  Thomas Coates of the University of California said that relying on one or two prevention strategies was like using ineffective monotherapy to treat HIV.  He argued that to succeed prevention requires behavioural change, such as reducing concurrent relationships and the use of condoms, using strategies such as circumcision and the prevention of mother to child transmission, the treatment of HIV and other viruses and sexually transmitted infections and social justice and human rights. Prevention successes generally involve early efforts by the community - confronting stigma and denial and strong political leadership.  All speakers made it clear that behaviour change and new prevention technologies will only have a limited impact in areas without social justice and human rights.  This is hardly the first time that there has been a call for HIV prevention to address factors such as poverty and gender and social marginalisation however there is a real emphasis to see a shift from dealing with HIV as a short term emergency to taking a long term response.

It was suggested that prevention has not reversed the course of the epidemic for three reasons; the available interventions are not effective, there is not enough funding for prevention and funding is often wasted due to poor implementation, money is often poured into prevention whose efficacy is not then properly evaluated.  Stefano Bertozzi, Director of Economics at the National Institute of Health said that “we have done, without learning by doing”.  An element of operational research has to be built into every prevention programme.  In some countries, such as India, the improvement in efficiency has been consistent, while in others, including Russia and Mexico, there are enormous disparities.  Bertozzi added that future prevention funding should be tied to performance and a business model should be adhered to “you can’t imagine McDonalds not knowing how many hamburgers they’ve sold; but in prevention all we do is hand out money”.

With regard to the range of biomedical interventions available to block HIV, Nancy Padian of the Women’s Global Health Imperative spoke of the interventions that rely on the use of antiretroviral drugs (ARV’s).  The use of ARV’s to prevent mother to child transmission and in post-exposure prophylaxis is already well demonstrated.  On the topic of behaviour change the session warned prevention researches not to attempt to reduce sex to an antiseptic act.  Human beings engage in sex for a variety of motives - for procreation, for fun, for money or because they don’t have choice and HIV prevention requires not small but radical change.  There is a call for sustained political and technical leadership in HIV prevention and political courage on sexuality, gender, drug use and harm reduction - for HIV activists to get behind prevention.

All the speakers agreed that ‘magic bullet’ thinking should be a thing of the past in HIV prevention. “HIV prevention based upon just one or two strategies in isolation may actually be counterproductive,”.  HIV prevention relies on finding solutions to a dizzyingly interlinked set of scientific sociological, structural and political problems, but there are enough positive models out there to know that they can be solved.

Source The Lancet Series in HIV prevention
The International AIDS Conference and Aidsmap