Intensifying Prevention

To get ahead of the epidemic, there is growing recognition that HIV prevention efforts must be scaled up and   intensified (UNAIDS,2005), as part   of  a   comprehensive   response   that simultaneously expands access to treatment and care.

 

Only through these fundamental efforts coupled with increased global and national commitment will the world be able to achieve universal access to the know how of preventive applications and truly begin to get ahead of
AIDS.

There is ample evidence that HIV doesyield to determined and concerted intervention. Sustained efforts in diverse settings have helped bring decreases in HIV incidence among men who have sex with men in many Western countries, among young people in Uganda, among sex workers and their clients in Thailand and Cambodia, and among injection drug users in Spain and Brazil. Now there is new evidence that prevention programmes initiated some time ago are currently helping to bring down HIV prevalence in Kenya and Zimbabwe, as well as in urban Haiti. 

 

But too often, prevention strategies are lacking sufficiency of scale, intensity and long-term vision. For prevention interventions to give the results necessary to get ahead of the epidemic, projects with short-term horizons must translate into long-term programmatic strategies. However, fundamental to all settings are comprehensive prevention strategies that include scale, intensity, consistency and sustainability as core requirements.

 

There are other basic approaches that can be applied to all HIV prevention efforts. First is the need to acknowledge that HIV prevention is a classic "public good" intervention that requires national governments and large public and private organizations to take the lead (including resource allocation) in building a strong response to the epidemic.

 

Second is the need to ensure that all HIV prevention strategies take into account the growing linkages between AIDS and factors that put people at greater risk of HIV infection, such as poverty, gender inequality,  and social marginalization   of    specific populations.

 

A broad approach across all prevention strategies also requires that stigma and discrimination be addressed, that those most at risk of HIV infection are effective[y reached, and that people living with HIV are engaged more fully in the AIDS response.

 

Putting HIV/AIDS into context and to be effective, HIV prevention programmes must address the contexts in which people live their lives. The rights and status of the breadwinner and the status of women and young girls deserve special attention. To   avoid new infections among children, prevention of mother-to-child transmission should be scaled to ensure that there is high-quality national coverage.

 

In recentyears, an international consensus on the need for a comprehensive response to HIV comprising prevention, treatment and care has strengthened. Political will has increased, as has advocacy by civil society groups. International and national funding available to the response to AIDS has greatly increased. These advances present an important opportunity to further intensify efforts and increase the momentum towards universal access to prevention, treatment and care for all countries affected by AIDS.

 

In June 2005, the UNAIDS governing Board comprising member states, co-sponsoring UN agencies and civil society groups endorsed a policy position paper for means to take action to intensify HIV prevention with the ultimate aim of achieving universal access to HIV prevention, treatment and care. This policy position paper included a compendium of proven programmes and actions that could be used to close the prevention gap as well as 12 essential policy actions that would be needed to ensure universal access.

At the 2005 G8 Summit in Gleneagles, members committed to develop and implement a package of HIV preventions, treatment and care, with the aim of achieving as closey as possible universal access to treatment for all those who need it by 2010. The United Nations General Assembly 2005 World Summit Outcome Document also adopted the concept of scaling up towards universal access.

It has been estimated that implementation of comprehensive HIV prevention programmes could avert 29 million (or 63%) of the 45 million new infections expected to occur between 2002 and 2010 (Stover etaL, 2002).

AIDS requires an intelligent, forceful and exceptional response. Uncoordinated efforts or those that provide only partial solutions will not bring about a significant reduction in the number of new infections.