CITATION: Policy Forum: HIV prevention for the next decade: Appropriate, person-centred, prioritised, effective, combination prevention
Peter Godfrey-Faussett, Luisa Frescura, Quarraisha Abdool-Karim, Michaela Clayton, Peter D. Ghys, (on behalf of the 2025 prevention targets working group)
Peter Godfrey-faussett et al.
PLOS Medicine, September 26, 2022
https://doi.org/10.1371/journal.pmed.1004102
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1...
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.
The overriding goal is: 95% of people at risk of HIV infection use appropriate, person-centred, prioritised, and effective, combination prevention options. This target, agreed by UN, appears to be ambitiously set for 2025: https://journals.plos.org/plosmedicine/article/figure?id=10.1371/journal...
From the text: 'The wide range of options for how to avoid infection with HIV includes behavioural as well as biomedical approaches. Choosing partners, including by HIV status and viral suppression status, choosing how and when sex happens, choosing condoms and lube, choosing PrEP, choosing to access sexual and reproductive health services (including antenatal care for pregnant women), choosing clean needles and syringes for injection, and choosing PEP. Individuals’ choices will vary over time and with different partners. It is appropriate that some approaches will be used on some occasions and not others.'
COMMENT (NPW): All of this requires access to reliable healthcare information - for the public, health workers and policymakers - to prevent, diagnose and manage HIV infection. This is barely mentioned in the paper, despite the fact that sexual and reproductive health information is the only area of health where access to information is recognised as a target.
Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org
Working in official relations with WHO
