Reassessing HIV Prevention
30 June 2008
Sir/ Madam
Reassessing HIV Prevention
The article by Potts et al (1) rightly highlights the need for the international community to refocus on HIV prevention. However as well as questioning their de-emphasis of the evidence for STI prevention it is unfortunate that they argue for investment in a limited number of interventions. We should be fully scaling up all the scientifically proven prevention strategies.
The prevention community could learn a lot from HIV treatment activism and treatment implementation. First, focus on what works and bring these interventions to scale and widespread coverage. Too much resource allocation is spent on interventions for which there is weak evidence. Only 8% of the 13 million injecting drug users have access to HIV prevention services and the global coverage of interventions for the prevention of mother to child transmission is just 11%.(2)
Second, mobilise communities for prevention. HIV treatment activism has focused efforts in prioritising and scaling up treatment. We need to mobilise and empower civil society and affected communities for prevention activism.
Third pay attention to, and remove the structural barriers that limit implementing prevention interventions, reducing the prices for HIV treatment dramatically increased treatment access (3, 4). By contrast, too little attention is paid to the policy and legal barriers which limit prevention programmes - be that needle and syringe programmes for injecting drug users; stigma and discrimination against men who have sex with men or sex workers; and gender inequality.
Finally, use a combination of prevention interventions. As frequently stated there is ‘no magic prevention bullet’ and prevention programmes should be tailored to the respective epidemic (5). Highly active combination therapy is significantly superior to single therapy (6) and it is likely that a combination of prevention interventions at scale will be more effective than championing one or two.
Dr Ade Fakoya,
Senior Advisor, International HIV/AIDS Alliance
- M. Potts et al., Science 320 , 749 (May 9, 2008).
- The Global HIV Prevention Working Group, (2007).
- D. B. Greco, M. Simao, AIDS 21 Suppl 4 , S37 (Jul, 2007).
- WHO Global Price Reporting Mechanism, “Prices paid for antiretroviral drugs by low and middle income countries in 2005-a summary report ” (2006).
- Unicef/who/unaids, Scaling Up Priority Interventions. (2007).
- S. M. Hammer et al., N Engl J Med 337 , 725 (Sep 11, 1997).
