The future of HIV prevention: control of sexually transmitted infections and circumcision interventions

Abstract

Prevention and control of sexually transmitted infections (STIs) has proven effective in reducing HIV infection when treatment is available promptly for symptomatic persons in conditions of an emerging epidemic. Biologically, it is assumed that reduced genital tract inflammation reduces infectiousness for HIV as well as reducing susceptibility in HIV-uninfected persons. Male circumcision has been demonstrated effective in reducing risk for HIV infection in three separate trials from South Africa, Kenya, and Uganda. Global expansion of STI treatment and male circumcision programs are vital tools for control of HIV infection; current evidence is reviewed and research priorities are presented.

Figure 1

A simple model of HIV prevention strategies that are either proven to work to reduce HIV incidence [e.g., behavior change to reduce risk, condoms as a physical barrier, needle exchange and treatment of opiate dependency to reduce injection drug-related risk] or that are in research development [e.g., physical barriers like the diaphragm for women, chemical barriers like microbicides, or immunological barriers like vaccines]. “OIs” refers to opportunistic infections whose treatment is associated with a small decline [0.2–0.5 log10 viral copies/mL plasma] in HIV viral load, thereby probably making persons less infectious.