HIV/AIDS: Experts call for scaling up of prevention programmes

By Henry Neondo

In a new report released yesterday, a panel of leading AIDS experts calls for a major scale-up of global HIV prevention programs, citing new data projecting that expanded access to prevention could avert approximately 30 million of the 60 million HIV infections expected to occur by 2015.

The report, released by the , warns that prevention efforts are not keeping pace with the gains being made in treating people infected with HIV. For every person who began antiretroviral therapy in 2006, six people were newly infected.

"We need to make the same gains in HIV prevention that we are making in HIV treatment," said Helene Gayle, president and CEO of CARE USA and co-chair of the Working Group.

"We have a critical window of opportunity over the next 10 years to dramatically slow the rate of new infections, and ultimately reverse the epidemic."

"It’s widely assumed that HIV continues to spread because prevention isn’t effective, and that’s simply not true. The problem is that effective prevention isn’t reaching the people who need it," said David Serwadda, MBChB, M.P.H., director of the Institute of Public Health at Makerere University in Uganda, and co-chair of the Working Group.

The report, titled Bringing HIV Prevention to Scale: An Urgent Global Priority, finds that scientifically proven prevention programs – such as those to reduce the risk of mother-to-child HIV transmission – are not being implemented on a sufficient scale, meaning they do not reach enough people, with enough intensity, to curb the epidemic.

The report recommends that global spending on AIDS double over the next three years, and calls on governments and donors to ensure that resources are spent on proven prevention strategies targeted to people at highest risk.

The Working Group is an international panel of more than 50 leading public health experts, clinicians, researchers, and people affected by HIV/AIDS. It is co-convened by the Henry J. Kaiser Family Foundation and the Bill & Melinda Gates Foundation.

If prevention efforts continue at current levels, 60 million new HIV infections are estimated to occur globally by 2015. During this time, the annual number of new HIV infections, currently nearly 5 million per year, would increase approximately 20%.

However, by fully scaling up all scientifically proven prevention strategies, an estimated 30 million of the 60 million infections expected to occur by 2015 could be averted. With expanded prevention, the annual number of new infections would drop to 2 million per year by 2015 - a level that may cause the epidemic to move into long-term decline.

Adding male circumcision to prevention programs would account for 8% of the drop in infections by 2015, a significant impact for a single intervention. This underscores the potential power of male circumcision as a prevention tool, provided it is used in combination with other proven prevention strategies - including AIDS education, condoms, HIV testing, and prevention of mother-to-child transmission.

"While adult male circumcision can be an important addition to prevention programs, no single prevention strategy is 100% effective," said Salim Abdool Karim, MBChB, Ph.D., pro-vice chancellor for research at the University of KwaZulu-Natal in South Africa, and a member of the Working Group. "We need to use all proven prevention strategies in combination."

But today, most prevention strategies are accessible to fewer than 1 in 5 people who could benefit from them - a level too low to have a significant impact on the epidemic.

For example, according to the latest data from UNAIDS and the World Health Organization, just 11% of HIV-infected pregnant women had access to an inexpensive course of antiretroviral drugs that can greatly reduce the risk of mother-to-child HIV transmission, only 12% of men and 10% of women in Africa had received an HIV test and knew their status in 2005 and that effective HIV prevention services reached only 9% of men who have sex with men, 8% of injection drug users, and fewer than 20% of commercial sex workers.

The report also notes that far too little has been done to address underlying factors that increase HIV risk - such as poverty, gender inequalities, and lack of reproductive health care.

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