Dr. B,

HIV prevention isn't all that complicated. Just use condoms. End of story. Right?

Zeb

Hi Zeb,

Well, I agree condoms may be the most effective HIV-prevention tool we have to date. However, it is far from the only tool or intervention in the prevention armamentarium! Effective HIV prevention is far more complicated than you might imagine and condoms alone are not the "end of story" solution to the HIV pandemic! I believe a "prevention spectrum" is really the best way to think about an effective HIV prevention strategy.

We know that what we are currently doing is not working. How do we know that? Simply by looking at the rate of new HIV infections that are occurring across the globe each year. Even in the U.S. the number of new HIV infections has not declined. In fact the number of new infections per year has increased to 56,300 per year!! A key point to remember is that HIV is 100% preventable using the tools and knowledge we have today.

An effective prevention strategy should begin well before a potential HIV exposure with science-based, age-appropriate sex education that emphasizes STD awareness and prevention. In addition pre-exposure prevention strategies should include behavior change for those participating in risky sexual or drug-injecting activities. We also need to increase clean-needle exchange programs, STI treatment programs, circumcision (especially in resource-poor countries) and availability of PrEP (if it is proven to be effective).

Prevention strategies at the time of exposure would include condoms (both male and female), antiretroviral therapy to prevent mother-to-child transmission in HIV-positive pregnant women. We are also working to develop effective microbicides for vaginal and rectal use and more effective cervical barriers (diaphragm).

Finally, preventive measures even after exposure should be ramped up. These include increased awareness and availability of PEP (post-exposure prophylaxis) and increased testing to identify those who are infected so that risky behaviors can be modified and treatment begun. HIVers with undetectable viral loads have a significantly decreased risk of transmitting the infection to others. Likewise prompt recognition and treatment of concurrent STIs can decrease the risk of transmission of HIV to HIV-negative sexual partners.

Eventually we hope to develop the ultimate HIV-prevention tool, an effective preventative vaccine. However, such a vaccine is not even on the distant horizon yet. Consequently for now and the foreseeable future we should more effectively utilize the entire HIV-prevention spectrum armamentarium, including but not limited to male condoms.

Dr. Bob