IV. Bringing Comprehensive HIV Prevention to Scale
July 6, 2004
Although prevention is the mainstay of the response to AIDS, fewer than one in five people worldwide have access to HIV prevention services. Comprehensive prevention could avert 29 million of the 45 million new infections projected to occur this decade. Although antiretroviral treatment is bringing hope to millions, without sharply reducing the number of new HIV infections, expanded access to treatment becomes unsustainable. Providers of antiretroviral treatment will be swamped by demand.
Prevention programmes are not reaching the people who need them, especially two highly vulnerable groups -- women and young people. In order to prevent the high infection rates among women, the root causes of their vulnerability -- their legal, social and economic disadvantages -- must be addressed.
For young people, knowledge and information are the first line of defence; AIDS education is still far from universal. In sub-Saharan Africa, only 8% of out-of-school young people and slightly more of those in-school have access to education on prevention. They also need access to confidential health information and condoms. Protecting the rights of young girls is also key to lowering HIV prevalence among young people.
There are success stories. A number of countries, including Brazil, the Dominican Republic, Uganda and Thailand, have succeeded in reducing HIV infection. There is also a need for HIV prevention to evolve and be more innovative in addressing changes in the epidemic. In high-income countries, for example, risk behaviours and new infections are rising again, particularly among young men who have sex with men. The reasons probably include "prevention fatigue" and complacency rising from the availability and promise of antiretroviral treatment.
Expanded access to antiretrovirals and other treatment offers a critical opportunity to strengthen prevention efforts by encouraging many more people to learn their HIV status. The promise of treatment should encourage greater use of voluntary counselling and testing. The current reach of HIV testing is poor. The proportion of adults needing voluntary counselling and testing who received it ranged from almost none in South East Asia to 7% in sub-Saharan Africa, and 1.5% in Eastern Europe. Where services do exist, uptake is also often low because of fear of stigma and discrimination.
Key elements in comprehensive HIV prevention include:
This article was provided by UNAIDS. It is a part of the publication 2004 Report on the Global AIDS Epidemic. Visit UNAIDS' website to find out more about their activities, publications and services.