Understanding Combination Prevention: the way forward for effective HIV prevention ......

Understanding Combination Prevention: the way forward for effective HIV prevention

This is the reasonable way forward. Unfortunately, this is not a guiding principle applied systematically in HIV prevention, noted Dr Carlos Caceres while given his talk during the plenary session on the 21st of July, 2010.

Combination prevention required that multiple strategies are mutually coordinated and supported to ensure national impact. Currently, most programmes are dispersed, focused on behavioural communication and counselling, poorly disseminated, focused on the short term changes due to the need programe demand for immediate results. These programmes are limited and poorly evaluated and so there was limited understanding of the impact of these programmes. Worsestill, only 7% of total HIV spending was spent on HIV prevention and less than 1% is focused on MARPs.

What is combination prevention: The concept of combination prevention is an analogue to combination treatment. Currently, the concept is used in more than one way (i) combination of 2 or more intervention strategies (ii) combination of diverse strategies to meet the HIV prevention needs of different subpopulations.  (iii) strategic combination of biomedical (Male circumcision, PEP, PMTCT, ARV treatment), behaviour (BCC) and structural interventions  to address key causes of HIV risk and vulnerability in a particular population. The third definitiion is that agreed to by UNAIDS Working Group.

What are structural interventions:  These are interventions that addresses the political, physical and social domains that drives the epidemic. These will mean focusing on aspects of the environment that increases people vulnerability to HIV and decreases access; change in law and regulations; promotion of changes in cultural and social norms, creating a supportive environment; community mobilisation and empowerment; and fostering social inclusion. Good prevention planning includes understanding of human rigths far beyond protecting human rights.

Impact of combination prevention on HIV prevalence: if HIV prevention programming continues status quo, 44 million new cases of HIV will be recorded over the next 25 years. With combination prevention, there will be 29 million new cases. This means that 66% new cases are averted. In addition, structural interventions have borade development effects including addressing poverty and gender inequality. The AVAHAN project in India is an example of such structural interventions with success story amongst many others.

Take home message:  focusing on individuals for prevention is not sufficient. Combination prevention is strategic, evidence informed combining behavioural and biomedical interventions with structural strategies in a human right framwork. This will need a sustained long term response and cannot be implemented in a rigid framework.

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