HIV prevention for the next decade: Appropriate, person-centred, prioritised, effective, combination prevention

Abstract

UNAIDS and a broad range of partners have collaborated to establish a new set of HIV prevention targets to be achieved by 2025 as an intermediate step towards the sustainable development target for 2030. The number of new HIV infections in the world continues to decline, in part due to the extraordinary expansion of effective HIV treatment. However, the decline is geographically heterogeneous, with some regions reporting a rise in incidence. The incidence target that was agreed for 2020 has been missed. A range of exciting new HIV prevention technologies have become available or are in the pipeline but will only have an impact if they are accessible and affordable and delivered within systems that take full account of the social and political context in which most infections occur. Most new infections occur in populations that are marginalised or discriminated against due to structural, legal, and cultural barriers. The new targets imply a new approach to HIV prevention that emphasises appropriate, person-centred, prioritised, effective, combination HIV prevention within a framework that reduces existing barriers to services and acknowledges heterogeneity, autonomy, and choice. These targets have consequences for people working in HIV programmes both for delivery and for monitoring and evaluation, for health planners setting local and national priorities, and for funders both domestic and global. Most importantly, they have consequences for people who are at risk of HIV exposure and infection. Achieving these targets will have a huge impact on the future of the HIV epidemic and put us back on track towards ending AIDS as a public health threat by 2030.

Longitudinal population-level HIV epidemiologic and genomic surveillance highlights growing gender disparity of HIV transmission in Uganda

“…2a shows the age profile of the estimated male and female sources of infection, such that the male plus the female sources sum to 100% for each survey round. Overall, we found that the contribution of men to onward transmission increased progressively from 57.9% [56.1-59.6] in 2003 to 62.8% [60.2-65.2] in 2018, indicating that HIV transmission is now more disproportionely driven by men than has been the case previously.…”

“…Effective HIV interventions and services are essential to bring most African countries on track to end AIDS as a public health threat by 2030 and accelerate progress towards the vision of the UNAIDS “three Zeros” target: zero new HIV infections, zero discrimination, and zero AIDS-related deaths 60, 62 . Gender inequalities are among the main reasons why global targets on mass scale-up of HIV testing, biomedical interventions and on incidence reductions have not been achieved 63 .…”

How PrEP delivery was integrated into public ART clinics in central Uganda: A qualitative analysis of implementation processes

“…This resonated with couples and made them feel valued and heard. "Person-centered" approaches to services are recognized as an essential component of high-quality healthcare [28][29][30], particularly in HIV prevention and treatment [31][32][33]. Person-centered services respect individual preferences, PLOS GLOBAL PUBLIC HEALTH are contextually-appropriate, and place wellbeing, agency and empowerment at the center of the health response.…”

Follow-up after post-exposure prophylaxis before and during the COVID-19 pandemic in Brazil

“…Combination prevention programs include a mix of evidence-based biomedical, behavioral, and structural interventions to meet the current HIV prevention needs of individuals and communities, aiming for the greatest possible impact on reducing the number of people newly infected 2 . They must be appropriate to each individual's circumstances and HIV vulnerability 3 . Globally, gay men and other men who have sex with men are 28 times more likely to be infected with HIV.…”