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AIDS experts call for global increase of HIV prevention efforts
If prevention efforts remain stagnant, experts estimate there may be 60 million new HIV infections worldwide by 2015.
In a report released by the Global HIV Prevention Working Group, experts said that HIV prevention efforts need to increase rapidly to match the accomplishments made in HIV treatment.
The report, titled “Bringing HIV Prevention to Scale: An Urgent Global Priority,” stated that HIV prevention programs are not being implemented sufficiently. Researchers estimate that by 2015, approximately half of the 60 million people expected to contract HIV will be diverted if there is an increase in prevention programs. With the additional programs, researchers estimate that the annual number of new infections will decrease to 2 million infections per year by 2015. Also, for every person who began antiretroviral therapy in 2006, six additional people contracted HIV.
“We have the potential to avert half of the HIV infections projected to occur by 2015 if we bring comprehensive, evidence-based HIV prevention services to scale in countries around the world,” Helene D. Gayle, MD, MPH, president and CEO of Cooperative for Assistance and Relief Everywhere Inc. (CARE USA) and co-chair of the Working Group, told Infectious Disease News. “Great strides have been made in increasing access to HIV treatment so we think the same can be done for HIV prevention.”
Increasing prevention programs
The Working Group commissioned the Futures Institute to develop estimated projections of the effect HIV prevention could have on the future of the epidemic. Projections included adult male circumcision, condom promotion, provisions for clean injection equipment to injection drug users, routine screening of donated blood and breast-feeding alternatives for mothers with HIV. Male circumcision alone is estimated to reduce HIV infections by 8% by 2015.
“Although adult male circumcision can be an important addition to prevention programs, no single prevention strategy is 100% effective,” Salim Abdool Karim, MBChB, PhD, pro-vice chancellor for research at the University of KwaZulu-Natal in South Africa and Working Group member, said in a press release. “We need to use all proven prevention strategies in combination.”
Currently, prevention programs only reach less than one person out of every five people with HIV. According to WHO and UNAIDS, 11% of pregnant women with HIV had access to inexpensive ART to reduce mother-to-child transmission of HIV in 2005; 12% of men and 10% of women with HIV living in Africa in 2005 had received an HIV test and were aware of their status; and in 2005, HIV prevention programs reached 9% of men who have sex with men, 8% of injection drug users and less than 20% of commercial sex workers.
“Countries must ensure that the right HIV prevention interventions are being used and that they’re appropriately targeting populations most at risk for infection,” Gayle said. “For example, in some countries with an HIV epidemic concentrated among marginalized populations such as sex workers, MSM or injection drug users, prevention programming is focused on the general population.”
Resources needed
Since 2001, funding for HIV has increased sixfold; however, it is still half of what UNAIDS recommends. The Working Group called for global AIDS funding to double within the next three years from currently $10 billion annually to $22 billion by 2010, with half of the funding dedicated to prevention.
“Because each country’s epidemic is unique, each country should develop its own comprehensive, national HIV prevention strategy through an inclusive process that involves multiple stakeholders, including civil society,” Gayle said. “The plan should be informed by a careful analysis of the dynamics of HIV incidence in the country, and include prevention targets, strengthened surveillance systems and integrated approaches to HIV prevention and treatment.”
As AIDS spending increases, governmental and international donors need to make sure resources are strategically used, according to the report. Other recommendations include a reservoir of supplies in health care settings for the prevention of HIV transmission and the collaboration of multilateral and technical agencies to provide countries with an assessment of national plans for HIV prevention, treatment, care and support. “It is important that countries tailor their prevention programming to fit the dynamics of the country’s epidemics,” Gayle said. – by Pam Rothman
More echoes of King Holmes’s insistence that treatment programs alone are doomed to fail in the global public health arena.
– Theodore C. Eickhoff, MD
Chief Medical Editor
For more information:
- To view the Global HIV Prevention Working Group’s report in full, visit www.globalhivprevention.org.