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Overview of HIV Prevention

Joseph J. Eron, Jr., MD
Program Director
Daniel R. Kuritzkes, MD
Program Director
Sharon L. Hillier, PhD
Released: September 17, 2020

Building a Combination Approach to HIV Prevention

The HIV prevention research field has been highly productive in recent years, reporting the results of multiple studies evaluating new prevention approaches. HIV prevention trials are expensive, time-consuming, and extraordinarily difficult to implement because of the need to include counseling for safer sex, treatment of sexually transmitted infections, as well as the need to monitor and improve participant adherence to the intervention being evaluated.

Despite these considerable obstacles, most HIV prevention trials are being done with admirable quality, participant retention, and community engagement. A key lesson from the successful studies evaluating male circumcision is the need to consider how an intervention shown to be successful within a clinical trial setting might be implemented more broadly. Planning for implementation will require engagement from investigators, community stakeholders, funders, and ministries of health. Because even a modestly effective intervention could have a significant impact on HIV incidence if the intervention is widely available in the targeted community and easy to use, the question then is: How effective does an intervention need to be before it is implemented widely?

In evaluating the range of prevention options currently available and anticipated to emerge in the coming years, it is clear that there will likely be no single intervention—no matter how accessible—with the level of effectiveness needed to change the trajectory of the HIV epidemic. There is an increased recognition by most HIV prevention researchers that a combination of prevention approaches will be needed and that the ‘package’ of interventions implemented will likely depend on the specific characteristics of a community, such as the prevalent modes of HIV transmission and the larger biomedical infrastructure in the community, as well as the support services needed in order to effectively roll out an intervention.

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