HIV Prevention

How can HIV be prevented?

Preventing the spread of HIV requires a multi-pronged approach:

• Education and awareness raising is key so that people can understand how HIV is spread and take action to reduce their chances of being infected.
• Condoms are a simple and effective way of preventing HIV transmission during sex.
• Needle exchange programmes can prevent HIV spreading by drug users sharing infected needles.
• Providing testing services to find out your HIV status is another crucial part of prevention. People who know they are HIV-positive are better able to take precautions to protect their families and partners, as well as getting treatment for themselves.
• Access to antiretroviral treatment is also a key part of HIV prevention. If there is no possibility of treatment, there is little incentive to know your status. People who are on treatment are also less infectious.

Undermining the stigma and discrimination that surround HIV is a huge challenge, but really important to make HIV prevention efforts work.

Who should HIV prevention programmes be targeted at?

Each country is affected by HIV differently. In most countries in sub-Saharan Africa, HIV is spread mainly through heterosexual sex and is widespread through the whole population. In most other regions of the world, HIV is predominantly concentrated in particular groups like drug users, sex workers and men who have sex with men. 

In most countries women, poor and marginalised people are also more vulnerable. It is really important to understand who is most affected and most vulnerable in a particular area so that appropriate prevention programmes can be put in place.

Are any other prevention breakthroughs likely?

Progress on a vaccine against HIV has been very slow and there is little likelihood of a breakthrough for many years to come. There has been more progress on developing microbicides for women. These gels or creams, applied internally before sex, would provide an ‘invisible’ alternative to condoms for women who are not able to negotiate condom use with their partners. But these too are still some years away.

Recent studies have shown that circumcision can reduce the chances of men being infected during sex by up to 50%, but adult circumcision is not straightforward medically, and routine circumcision of children is a complex cultural and ethical issue.

What is the ‘ABC’ approach?

‘ABC’ is an approach to HIV prevention that stands for abstinence, being faithful and using condoms. The US President's Emergency Plan for AIDS Relief (PEPFAR) – started under George Bush Jr. – has used this approach. But its version has focused more on abstinence, particularly for youth, and only promoted condoms for people who practice ‘high risk’ behaviours; shorthand for sex workers, drug users and men who have sex with men.

This version of ABC ignores the fact that many women may not be in a position to refuse sex, or that they may be faithful (especially within marriage) while their partners are not.

Why has US funding of HIV programmes been controversial?

PEPFAR has provided billions of dollars for HIV programmes. However some of that money has been specifically earmarked for work that promotes abstinence (and specifically not condoms) as the best way to avoid HIV. This is controversial as evidence shows that the promotion of abstinence by itself does not work.

Also, the US government’s stance on abortion has made integration of HIV and sexual and reproductive health more difficult, while US opposition to the legalisation of sex work has undermined some HIV work with commercial sex workers.

Why has education been described as a ‘social vaccine’ against HIV?

Education has been described by the UN and the World Bank as the ‘single most effective preventive weapon against HIV', and a ‘social vaccine’. School education appears to affect knowledge of the disease, and studies suggest education is also the best way to change sexual behaviour.

For example, in Uganda young people's risk of contracting HIV appeared to drop by 50% if they completed their primary education, even without education that is specifically about HIV.

Research has also suggested a link between women’s literacy and their level of understanding about the prevention of HIV. Other studies indicate that education can make young men more likely to use condoms.