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Maximizing the impact of HIV prevention technologies in sub‐Saharan Africa

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      Successes and challenges of HIV prevention in men who have sex with men.

      Men who have sex with men (MSM) have been substantially affected by HIV epidemics worldwide. Epidemics in MSM are re-emerging in many high-income countries and gaining greater recognition in many low-income and middle-income countries. Better HIV prevention strategies are urgently needed. Our review of HIV prevention strategies for MSM identified several important themes. At the beginning of the epidemic, stand-alone behavioural interventions mostly aimed to reduce unprotected anal intercourse, which, although somewhat efficacious, did not reduce HIV transmission. Biomedical prevention strategies reduce the incidence of HIV infection. Delivery of barrier and biomedical interventions with coordinated behavioural and structural strategies could optimise the effectiveness of prevention. Modelling suggests that, with sufficient coverage, available interventions are sufficient to avert at least a quarter of new HIV infections in MSM in diverse countries. Scale-up of HIV prevention programmes for MSM is difficult because of homophobia and bias, suboptimum access to HIV testing and care, and financial constraints. Copyright © 2012 Elsevier Ltd. All rights reserved.
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        Integrating demographic and epidemiological approaches to research on HIV/AIDS: the proximate-determinants framework.

        This article presents a conceptual framework for the study of the distribution and determinants of human immunodeficiency virus (HIV) infection in populations, by combining demographic and epidemiological approaches. The proximate-determinants framework has been applied extensively in the study of fertility and child survival in developing countries. Key to the framework is the identification of a set of variables, called "proximate determinants," that can be influenced by changes in contextual variables or by interventions and that have a direct effect on biological mechanisms to influence health outcomes. In HIV research, the biological mechanisms are the components that determine the reproductive rate of infection. The proximate-determinants framework can be used in study design, in the analysis and interpretation of risk factors or intervention studies that include both biological and behavioral data, and in ecological studies.
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          Combination HIV prevention for female sex workers: what is the evidence?

          Sex work occurs in many forms and sex workers of all genders have been affected by HIV epidemics worldwide. The determinants of HIV risk associated with sex work occur at several levels, including individual biological and behavioural, dyadic and network, and community and social environmental levels. Evidence indicates that effective HIV prevention packages for sex workers should include combinations of biomedical, behavioural, and structural interventions tailored to local contexts, and be led and implemented by sex worker communities. A model simulation based on the South African heterosexual epidemic suggests that condom promotion and distribution programmes in South Africa have already reduced HIV incidence in sex workers and their clients by more than 70%. Under optimistic model assumptions, oral pre-exposure prophylaxis together with test and treat programmes could further reduce HIV incidence in South African sex workers and their clients by up to 40% over a 10-year period. Combining these biomedical approaches with a prevention package, including behavioural and structural components as part of a community-driven approach, will help to reduce HIV infection in sex workers in different settings worldwide. Copyright © 2015 Elsevier Ltd. All rights reserved.

            Author and article information

            [ 1 ] Infectious Disease Epidemiology Imperial College London London United Kingdom
            [ 2 ] Bill & Melinda Gates Foundation Seattle WA USA
            [ 3 ] The Fenway Institute Harvard Medical School Boston MA USA
            Author notes
            [* ] Corresponding author: Helen Ward, Infectious Disease Epidemiology, School of Public Health, Norfolk Place, London W2 1PG, United Kingdom. Tel: +44 (0) 207 594 3303. ( h.ward@ )
            J Int AIDS Soc
            J Int AIDS Soc
            Journal of the International AIDS Society
            John Wiley and Sons Inc. (Hoboken )
            22 July 2019
            July 2019
            : 22
            : Suppl Suppl 4 , Maximizing the impact of HIV prevention technologies in sub‐Saharan Africa, Guest Editors: Helen Ward, Geoffrey P Garnett, Kenneth H Mayer, Gina A Dallabetta ( doiID: 10.1002/jia2.2019.22.issue-S4 )
            © 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.

            This is an open access article under the terms of the License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

            Figures: 2, Tables: 0, Pages: 6, Words: 5010
            Funded by: Bill & Melinda Gates Foundation
            Award ID: ID 46981
            Funded by: Imperial NIHR Biomedical Research Centre
            Custom metadata
            July 2019
            Converter:WILEY_ML3GV2_TO_NLMPMC version: mode:remove_FC converted:22.07.2019


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