Behavioral and biomedical combination strategies for HIV prevention

Abstract

Around 2.5 million people become infected with HIV each year. This extraordinary toll on human life and public health worldwide will only be reversed with effective prevention. What's more, in the next few years, it is likely at least, that no single prevention strategy will be sufficient to contain the spread of the disease. There is a need for combination prevention as there is for combination treatment, including biomedical, behavioral, and structural interventions. Expanded HIV prevention must be grounded in a systematic analysis of the epidemic's dynamics in local contexts. Although 85% of HIV is transmitted sexually, effective combinations of prevention have been shown for people who inject drugs. Combination prevention should be based on scientifically derived evidence, with input and engagement from local communities that fosters the successful integration of care and treatment.

Figure 1.

Highly active HIV prevention, a term coined by King Holmes, University of Washington School of Medicine, Seattle, WA. (STI) Sexually transmitted infections (Coates and Gable 2008).

Figure 2.

The “ABC” HIV prevention campaign. Billboard in Botswana. Sexual HIV risk could be avoided altogether by avoiding any sexual activities that could cause transmission of HIV (A, Abstain) or through avoiding sexual intercourse other than with a mutually faithful uninfected partner (B, Be faithful) or through the correct and consistent use of condoms (C, Condomise).

Figure 3.

Testing coverage can be markedly increased by using a variety of nontraditional venues and outlets such as household campaigns, high-risk venues, work environments, and community-based mobile testing units such as The Tutu Tester is a mobile testing service operating in Cape Town, South Africa (van Schaik et al. 2010).

Figure 4.

HIV transmission is dependent on plasma viral load. Mean (+SE) rate of heterosexual transmission of HIV-1 among 415 couples, according to the sex and the serum HIV-1 RNA level of the HIV-1-positive partner (Quinn et al. 2000). At baseline, among the 415 couples, 228 male partners and 187 female partners were HIV-1-positive. The limit of detection of the assay was 400 HIV-1 RNA copies per milliliter. For partners with fewer than 400 HIV-1 RNA copies per milliliter, there were zero transmissions.