UNAIDS must prioritise prevention in HIV response

By Shaun Mellors

Shaun Mellors is the director of knowledge and influence at the International HIV/AIDS Alliance

A new report by UNAIDS highlights significant progress in the response to HIV globally, yet fails to emphasise the need to increase prevention work.

<p>Condom distribution through Link Up Uganda</p>Peer educator distributes condoms to youth in Naguru, Uganda © Peter Caton for International HIV/AIDS Alliance

The UNAIDS report (released 20 July) states that more than half of all people living with HIV worldwide are now receiving HIV treatment, and AIDS-related deaths have dropped by 36 percent since 2010. Collaborative efforts by all of us – communities, governments and multilateral agencies – have led to this changing reality for many people living with HIV.

Yet the number of new HIV infections remain unacceptably high. Despite the many achievements noted in the report, prevention is not on track. There were more than 1.8 million new infections in 2016 (down from 2.1 million in 2015), while the estimated numbers of new infections among key populations – such as sex workers, gay and other men who have sex with men, transgender people and people who inject drugs – continue to rise.

Lack of global leadership

More than 300,000 adolescent girls and young women, mostly in sub-Saharan Africa, were newly infected with HIV (UNAIDS). Globally agreed prevention targets are way off track because, often, HIV prevention services are still not targeting the right people in the right places.

There is a lack of political will to invest in systems that reach the populations who are most vulnerable and most stigmatised. Investment in HIV prevention programmes remains woefully inadequate and there is a visible lack of global leadership around HIV prevention.

If we are serious about achieving epidemic control and ending AIDS as a public health threat by 2030, we cannot afford to loosen our hold on any part of the global response, let alone one as important and underserved as preventing new infections.

People-centred health services

The World Health Organisation’s framework for integrated and people-centred health services offers the opportunity to shape combination HIV prevention services in a way that is centred around the person and their needs. As the primary custodians of their own health people need to be empowered to take effective decisions about their health, and communities to actively engage in the delivery of primary healthcare services.

A person-centred approach acknowledges that people’s prevention needs change over the course of their lives, and that those changes are due to a range of factors related to the individual (age, gender, lifestyle, economic situation) and to the surrounding environment (cultural norms, location, discriminatory laws, physical security).

A person-centred approach to delivering combination HIV prevention at scale means that planners and implementers must recognise:

  • people are best placed to decide which HIV prevention method is right for them when they are offered differentiated and integrated choices;
  • communities are effective partners in the delivery of prevention and care services, and can help alleviate overburdened health facilities;
  • strategic efforts to address the structural drivers of HIV transmission should be part of combination prevention packages.

Community-led response

By directly providing combination HIV prevention packages at community level and using effective referral systems, communities can stimulate demand and increase people’s opportunities to access a broad range of services and remain healthy.

For prevention efforts to be effective it is critical to include people living with HIV. This will help strengthen community systems, enabling communities to partner more closely with formal health services and contribute to building resilient, equitable and sustainable systems for health. Those systems would be better equipped to tackle not only HIV, but sexual and reproductive health and rights, malaria, tuberculosis and non-communicable diseases.

In October, UNAIDS will launch the Global Prevention Coalition in Nairobi, Kenya. The Alliance is an active member and contributor to this coalition, and we call upon UNAIDS and civil society organisations to put prevention right at the core of our movement to end AIDS.

The coalition must be bold and visionary in its agenda. We believe that:

  • HIV prevention should apply a person-centered approach.
  • The roles of civil society and community organisations as valuable partners to HIV prevention services delivery need to be fully recognised and adequately resourced.
  • Resources should be available for the full set of combination HIV prevention interventions and measurable targets should be set for all programme components, including behavioural and structural interventions.

Join us in getting HIV prevention back on track.