HIV prevention as we know it and have done it for the last 30 years is failing to put an end to the HIV epidemic. At best current prevention strategies appear to be containing HIV incidence at a rate of 2.7 million new infections a year after a peak at 3.5 million in 1996.
The recent acknowledgment that there is more to HIV prevention than the ABC of behaviour change and condoms and that key vulnerable populations have been largely ignored by prevention interventions (injecting drug users, men who have sex with men) is a welcome but late awakening.
Nevertheless, thirty years into the epidemic and in the absence of a cure or any other efficient means to protect oneself, there are still men and women who cannot or will not use condoms in situations where they are at risk of being infected. The reasons behind putting oneself at risk are multiple, complex and often beyond human rational decision making or their control.
In trying to address each of them, often in turn, independently and above all within the narrow epidemiological context of HIV, attempts at preventing HIV infection have resulted in limited outcomes and the fragmentation of the scarce resources allocated to target a global epidemic.
To date, of the prevention interventions tested in clinical trials, only four have shown a positive outcome: male circumcision, a complex and costly combination vaccine, an anti-retroviral-based microbicide whose efficacy hinges on adherence and a daily oral Pre-Exposure Prophylaxis using antiretrovirals commonly used to treat HIV-positive people.
Though these clinical studies open the way to more powerful interventions they are not good enough on their own to crush the current level of HIV infection and raise a number of questions and challenges.
incidence 0 aims at supporting and advancing the development of no-nonsense evidence-based HIV prevention interventions by providing a critical analysis of existing and new HIV prevention approaches and technologies.
No question should be ignored, no perspective disregarded. All opinions are worth considering because all those involved and dedicated to fighting the spread of HIV have one thing in common: they all want to bring HIV incidence down to zero.
This blog is managed, written and edited by Roger Tatoud during his spare time.
Views expressed on this blog do not necessarily reflect or represent those of the organisations the blogger works for or contribute to (as a matter of facts, this would be surprising, but creation is in contradiction). To get in touch use the contact form below.