Evidence-based strategies for preventing HIV transmission and the Thailand perspective

ABSTRACT

A wide range of HIV prevention strategies have been evaluated or are in late-stage clinical trials. These include male circumcision, microbicides, diagnosis and treatment of sexually transmitted diseases, barriers, pre-exposure and post-exposure sexual prophylaxis with antiretroviral drugs, and behavioral interventions. While condoms are widely available and highly effective if used consistently and correctly, they have not been the answer to the problem, with UNAIDS reporting that 2.7 million new HIV infections occur each year. Current behavioural prevention interventions have been associated with a decline in HIV prevalence in some settings but have yet to demonstrate a generalizable impact. Biomedical interventions, such as male circumcision, substitution therapy for injection drug users, management of sexually transmitted diseases, antiretroviral therapy, female barrier methods and topical microbicides offer promise, with many under investigation in clinical trials. However, no single biomedical or behavioral intervention is likely to be effective and the focus of research is switching to the investigation of combinations of strategies.This review examines proven biomedical methods of reducing HIV transmission, such as male circumcision, efforts which have failed (e.g. first generation microbicides) and strategies for the future, including pre-exposure prophylaxis and next generation microbicides. Behavioural interventions are the keys to any successful efforts to reduce HIV transmission. While such interventions may provide (short-term) changes in individual behavior, new strategies seek to effect behavioural change at a population level.