By Krishna Jafa on 20
July 2012
Co-written by Krishna Raja and Roxana
Rogers
In the coming days, the 19th International AIDS
Conference will gather more than 25,000 global leaders who are committed to
the fight against HIV, and who hold the power to shape
the global funding and policy agendas to combat the epidemic. This is a moment
of extraordinary scientific progress and potential, but the trajectory of the
global response to AIDS will depend heavily on our
ability to prevent new infections in the future.
Recent advances in HIV
prevention provide dramatic proof that past investments in research and program
development are paying off, and provides clear evidence that increased
investments can reap tremendous rewards. The AIDS
conference in Washington will serve as an urgent, science-driven call to
action, challenging all stakeholders to harness their expertise, energy and
resources to mount an effective and efficient response that can turn the tide
on HIV.
Now, more than ever, we need to
rearticulate our commitment to HIV prevention as an
essential component to an effective response to HIV and
AIDS. No single HIV prevention
method offers complete protection against HIV. By
offering a package of effective, evidence-based HIV
interventions together, we are better positioned to counter the epidemic in a
more comprehensive manner than would be possible with standalone interventions.
The strategy is working.
The rate of new HIV
infections and AIDS-related deaths are at the lowest
levels since the peak of the epidemic in 2001. The number of people living with
HIV decreased by more than 25 percent between 2001 and
2009 in 33 countries around the world. But while the overall number of new
infections is decreasing and access to treatment is increasing, there are still
two new HIV infections for every one HIV-infected
person placed on treatment.
While researchers and scientists work
to develop an effective vaccine, global health experts are implementing
programs that reflect a more holistic approach to HIV
prevention. A “combination package” approach incorporates biomedical
interventions and the promotion of healthier behaviors relevant to the local
epidemic context. It also addresses structural factors — social, economic and
political realities — that affect the ability of individuals and communities to
adopt safer behaviors and access prevention services.
The challenge is in creating a package
of prevention methods that is mutually reinforcing and tailored to individual,
community and country-specific contexts.
Fortunately, we are at a point in the
response where we now have a wide range of evidence-based interventions
available, such as the voluntary medical male circumcision, harm reduction for
people who inject drugs, male and female condoms, behavioral risk reduction,
and the use of antiretrovirals for both prevention and treatment.
But there is still room for
innovation.
Achieving an AIDS-free
generation will also continue to depend on our ability to invest in new
technologies that have the potential to reach more people. For example, recent
scientific advances in the design and application of voluntary medical male
circumcision devices could dramatically accelerate scale-up of the service by
making the procedure faster, simpler and easily delivered by health workers who
are not clinicians, while still ensuring safety and quality control.
The potential for impact is huge
considering medical male circumcision is a one-time procedure that provides a
lifelong benefit by reducing female-to-male transmission by up to 60 percent.
Mathematical models indicate that increasing circumcision services to 80
percent coverage in five years could prevent nearly 3.6 million infections
within 15 years. That translates to a net savings of US$16.5 billion due to
averted treatment and care costs.
Ultimately, the delivery of these
prevention packages relies heavily on collaboration among national governments,
international donors, implementing partners and the communities we aim to
serve. We also need a better understanding of costs for delivering combination
packages for different populations and in different contexts. This week, the
world’s political leaders will join leaders across all sectors to map the
future direction of the global response to the AIDS
epidemic. As the path is charted, continued donor support, increased
investments by affected countries, visionary leadership by leaders in these
countries, and an unshakeable commitment to the issue of prevention will be
critical if we are to turn the tide.
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Roxana Rogers is the director
of USAID’s Office of HIV/AIDS and Krishna Jafa the director of
sexual & reproductive health and TB at PSI.
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