press releases

HIV "prevention revolution" underway - but health systems must be ready to ensure access

Download this press release as a PDF

London, 4th January 2012

Protecting vulnerable people against HIV infection is getting easier, says a study in the latest issue of international journal Reproductive Health Matters. But the introduction of new prevention methods will mean radical rethinking of service delivery.

The new research and product development has three main strands: (1) a microbicide, to be used by women in the form of a vaginal gel or vaginal ring; (2) antiretroviral drugs - normally used to treat HIV - being used by non-infected people for prevention of infection; and (3) antiretroviral drugs used by HIV positive partners of uninfected people, which makes transmission less likely.

"People who are HIV negative are the ones for whom these products will be valuable," writes author Felicity Daly, a post-graduate student at the London School of Hygiene and Tropical Medicine, in the study, entitled The introduction of microbicides and other antiretroviral-based prevention methods into health systems: key issues. "Health policy makers will need to determine not only where within the health system these new prevention methods can be delivered, but [also] how to manage user access," Daly writes.

Many HIV programmes to date have focused on treating people who already have HIV. Preventing HIV transmission, meanwhile, has mainly involved promoting consistent and correct condom use and male circumcision, as well as treating infected women during and after pregnancy to protect babies. The shift to these new methods will therefore require a complete re-think of the way that services are delivered because they need to be aimed at those who are HIV negative.

Women in developing countries could be most affected by the breakthroughs. Microbicides, which must be used by the woman as a gel before and after sex, or via a ring inserted into the vagina, mean that women can protect themselves even if their partners refuse to use condoms. A July 2010 study showed that a microbicide gel containing the antiretroviral tenofovir could decrease the risk of HIV infection by 39%. A confirmatory trial is currently under way.

Using antiretroviral drugs to prevent infection has also proved effective. A December 2010 study showed that the antiretroviral combination Truvada reduced the risk of HIV infection in men who have sex with men by 44%. In May 2011 another study showed that early uptake of antiretrovirals for treatment reduced the risk of HIV transmission to an uninfected regular partner by at least 96%.

Family planning centres and youth-friendly reproductive health services should both be utilised to ensure that the effects of these exciting breakthroughs are felt, Daly suggests. Meanwhile "consistent leadership from UNAIDS, WHO and other multilateral partners is required," she writes, "to focus on a 'prevention revolution.'" In stretched health systems, can the funding, training, and space be found for preventative measures? To reduce the number of new HIV infections, ensuring access to these new methods may be the best hope yet.