June 5, 2011 marked 30 years since the first cluster of infections later confirmed as HIV/AIDS were reported by the US Centers for Disease Control and Prevention. Thirty years on, evidence of what works in HIV prevention is growing and this is changing how programs will be designed, and how resources will be allocated — including by our key HIV donors, PEPFAR and the Global Fund.
1. PSI’s comprehensive offering of HIV prevention and post-diagnosis interventions remains highly relevant. Since the 1980s, PSI has played a key role in the fight against HIV/AIDS by rapidly taking interventions with a strong evidence base from research to implementation. Where there is no evidence, we work to gather it in an objective manner.
Why is this important? See how what we offer fits with how key influencers and donors are thinking by reading the article from The Lancet (below and Figure 1, page 2), which recommends significant investments to scale up male circumcision, HIV counseling and testing/post-test support, condom promotion, prevention of mother-to-child transmission, behavior change to reduce sexual partners, and interventions targeting key populations (MSM, injecting drug users, sex workers).
2. Growing evidence for treatment as prevention is rapidly changing the prevention discourse. Last month, the HIV Prevention Trials Network (HPTN) announced its study found a 96% reduction in HIV transmission from HIV-infected to HIV-negative sex partners in the study group in which the HIV-infected partner started antiretroviral drugs immediately after being diagnosed with HIV, as compared to the control group.
Why is this important? With this study’s results, the importance of early HIV diagnosis and partner testing is clearer than ever. We offer HIV CT in 21 countries and are a global leader in couples CT. PSI launched a pilot ARV social marketing program in Myanmar in 2011 and will launch an ARV program in Zimbabwe in 2012. What we learn from these pilots will guide us in determining a role in treatment as prevention.
3. Tenofovir, an antiretroviral drug, may work as a microbicide in women. 1% Tenofovir gel, when applied vaginally within 12 hours before or after sex, reduced women’s risk of HIV acquisition by 38% in the still-ongoing CAPRISA 004 trial.
Why is this important? When completed, the trial is expected to show good results. PSI has closely followed this and is invited by WHO to provide new product launch and implementation guidance later this month.
4. Pre-exposure prophylaxis with ARVs or PreP may work in MSM and transgender women. The iPreX trial showed a 44% reduction in risk in the study group that took a once-daily combination antiretroviral drug, Truvada (tenofovir + emtricitabine).
Why is this important? PSI continues to follow PreP trials, as proven PreP regimens may become important for key populations such as MSM. PSI will participate in a meeting among policy makers, donors and implementers to discuss PreP implementation possibilities at next month’s International AIDS Society meeting.
While the above is reason for optimism and for continued efforts by PSI to remain a global leader in HIV prevention, an efficacious vaccine remains elusive, as does finding a way to reduce risk of HIV acquisition among people infected with Herpes Simplex Virus type 2.
— Krishna Jafa, Director, Sexual & Reproductive Health & TB, PSI
