The estimated number of new HIV infections around the globe has not changed in several years. Almost two million people began to live with the virus last year. And the previous year. And the year before that. It is about time that the World AIDS Day campaign decided to ‘target’ HIV prevention.

I like the image that UNAIDS has chosen for the annual campaign leading up to World AIDS Day. I think it is a left hand with things written on it that give us all a lot to think about. Some of the interventions written on the hand prevent HIV infection and some do not. There is firm scientific evidence that the first three are effective.

http://drive.google.com/open?id=0B4b4EaDfnQG0ajZJay1CRDY5UWs

1) Condoms are right in the centre of the palm where they belong. Male condom use is one of the few practices that has been proven to decrease the chance of HIV acquisition and transmission. Female condoms do not have as long a history of use, but it is known that they prevent sexually transmitted infections. The effectiveness of condoms in reducing HIV incidence in a population depends on the frequency of use, the frequency of sexual partner change, and the nature of sexual networks in a population.

2) The ring finger has harm reduction reduction on it. Parts of the harm reduction package of interventions reduce HIV incidence. Both needle and syringe programmes and opiate substitution therapy among people who inject drugs decrease HIV incidence. Education, if combined with one of the above two, works. Condoms are also effective. Six other interventions in the UN technical guidance for people who inject drugs have not been proven to prevent HIV transmission

3) VMMC is written on the wrist. Adult circumcision decreases the incidence of HIV in men but does not decrease incidence in women. So it is an effective, if limited, method of HIV prevention.

The rest of the activities are, I’m sorry to say, not as effective in reducing incidence.

PrEP is on the thumb. As a personal prevention intervention, pre-exposure prophylaxis is effective in preventing HIV acquisition. There is no community trial evidence that it decreases incidence in a population. HIV treatment is also an effective personal prevention intervention for the seronegative partner in serodiscordant couples but there is as yet no firm evidence from trials that ‘treatment as prevention’ is effective in decreasing incidence in the community.

There are a few terms left on the image of the hand.

‘No violence’ is good. I am against violence. Organised violence such as wars have been found to have both positive and negative influences on epidemics. Gender based violence has been found to increase incidence in women but there is yet very little evidence that programmes to decrease it have an impact on incidence. Zero discrimination is a fine aspirational goal. So is promoting the right to health.

Comments? Criticisms? World AIDS Day is coming up.

Jamie

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