2015 Fast-Tracking Combination Prevention

19 Octo­ber 2015

Analysis of evidentiary value

This report was issued by the Sec­re­tariat of the Joint Pro­gramme in the United Nations on HIV/AIDS (UNAIDS)–a coali­tion of 11 UN agen­cies and the World Bank help­ing to coor­di­nate the global AIDS response by engag­ing with gov­ern­ments, civil soci­ety and peo­ple liv­ing with HIV.

UNAIDS is over­seen by a Pro­gramme Coor­di­nat­ing Board com­posed of rep­re­sen­ta­tives from 22 geo­graph­i­cally diverse coun­tries; the 11 UN agen­cies, includ­ing the World Health Orga­ni­za­tion, UN Women, and the United Nations Pop­u­la­tion Fund; and five non­govern­men­tal organ­i­sa­tions. UNAIDS is the only UN entity that has rep­re­sen­ta­tives of civil soci­ety on its board.

This report explores how pre­vent­ing HIV infec­tion among peo­ple over 15 years of age is cru­cial to the global goal of elim­i­nat­ing AIDS.

Used as precedent

combination prevention

Sev­eral HIV pre­ven­tion meth­ods have proved effec­tive when used con­sis­tently, but no sin­gle pre­ven­tion approach has the abil­ity to stop the epi­demic on its own. Com­bi­na­tions of pre­ven­tion inter­ven­tions are needed. Dif­fer­ent set­tings and pop­u­la­tions will require dif­fer­ent com­bi­na­tions of inter­ven­tions. The best HIV pre­ven­tion impact comes from offer­ing a pack­age of inter­ven­tions care­fully selected to suit the epi­demic set­ting and the pop­u­la­tion.HIV pre­ven­tion resources should be focused more intensely on geo­graphic areas at ele­vated risk. Recent mod­el­ling found that in Kenya a uni­formly dis­trib­uted com­bi­na­tion of pre­ven­tion approaches could reduce new HIV infec­tions by 40% over 15 years. But new infec­tions could be reduced by another 14% if a pre­ven­tion strat­egy with the same bud­getary resources focused on peo­ple and loca­tions of great­est risk. India has used geo­graph­i­cal and pop­u­la­tion pri­or­i­ti­za­tion in its pre­ven­tion efforts and, as a result, has seen a marked decrease in new infec­tions between 2000 and 2010.More than ever before, it is crit­i­cal that national HIV pre­ven­tion responses focus on com­bi­na­tions of these proven high-impact tools, includ­ing con­doms, VMMC, PrEP and ART. Con­text-spe­cific, evi­dence-based behav­ioural and struc­tural pro­gramme ele­ments are impor­tant as well. Approaches pro­vid­ing basic knowl­edge, aware­ness and gen­eral behav­iour change mes­sages need to be replaced with approaches informed by local evi­dence on fac­tors shap­ing behav­iours and pro­gramme mod­els, which have been effec­tive in achiev­ing the intended out­comes in sim­i­lar con­texts.