Bringing HIV Prevention to Scale: An Urgent Global Priority

In this 36-page report, available in English, French, Russian, and Spanish, released in June 2007 by the Global HIV Prevention Working Group, a panel of AIDS experts call for a major scale-up of global HIV prevention programmes. According to the document, a rise in treatment and the investment needed for this treatment has not been matched by a rise in HIV prevention or investment in prevention strategies. This failure is analysed, impediments are discussed, and successful prevention scale-up is described. Programmes in Thailand, Uganda, Brazil, and Senegal are highlighted, as well as key prevention services, including HIV testing, condom promotion, mass media campaigns, and focused programmes for youth, mothers, injection drug users, sex workers, and men who have sex with men (MSM).


As stated in the executive summary, scaling up prevention is critical because "[f]or every patient who initiated antiretroviral therapy in 2006, six other individuals became infected with HIV... [E]ven in the midst of global failure to make optimal use of available prevention strategies, a number of countries, including some of the world’s poorest, have made tangible progress in reducing the number of new HIV infections through implementation of comprehensive HIV prevention efforts. Strong evidence and replicable models exist for HIV prevention scale-up, underscoring the need to move beyond localized pilot projects to broad-based, comprehensive national programs."


Scaling up strategies involve using an array of "proven tools". These include a number of communication-related tools and strategies; among the 23 tools listed are the following:

1. Preventing Sexual Transmission:
• Behaviour-change programmes (to increase condom use, delay initiation of sexual behaviour in young people, and reduce the number of partners).
• Condom promotion.
2. Social Strategies and Supportive Policies:
• HIV awareness campaigns (including mass media).
• Anti-stigma measures.
• Gender equity and women’s empowerment initiatives.
• Involvement of communities and HIV-infected individuals.
• Visible political leadership.
• Engagement of a broad range of sectors in HIV awareness and prevention measures.
• Legal reform to create an environment supportive of HIV prevention (such as laws decriminalising needle possession).

Some factors increasing HIV vulnerability, which could be addressed by policy actions are:

• Gender Inequality.
• Institutionalised Discrimination Against Vulnerable Groups.
• Conflict and Humanitarian Emergencies.
• HIV Stigma.
• Poverty.

Some of the communication successes cited are:

• HIV Testing - Building on successful strategies used in prior national vaccination campaigns, workers in the “Know Your Status” campaign are going door to door to offer free testing services.
• Condom use - Brazil has energetically promoted condoms through mass media initiatives that also emphasise HIV testing. In 2006, the government distributed 25 million free condoms at the annual Carnaval festival in Rio de Janeiro.
• Mass Media - While mass media alone is not sufficient as a prevention strategy, mass media efforts are associated with increased HIV knowledge, increased condom use, and improved interpersonal communication about HIV among sex partners. For example, in Cambodia, a national mass media awareness initiative supported by the BBC World Service Trust has reached 97% of the population.
• Prevention Programmes for Young People - South Africa’s loveLife programme provides an example of a nationally scaled, comprehensive, evidence-based approach to HIV prevention for young people. Programme components include the establishment of youth-friendly health services in public clinics; a national network of youth centres; community-level outreach and support to young people through schools and other venues; a national toll-free hotline; and a sustained multimedia HIV education and awareness campaign.
• Prevention of Mother-to-Child Transmission - Access to HIV counseling and testing plays a central role in PMTCT scale-up. For example, in Ukraine, where PMTCT coverage is highest, implementation of “opt-out” HIV counselling and testing in antenatal clinics significantly increased uptake of HIV testing among pregnant women.
• HIV Prevention for Injection Drug Users - A key element of Iran’s clinic model for injection drug users is the clinics’ sustained advocacy for a public policy environment conducive to harm reduction. Common features of high-coverage programmes for injection drug users include involvement of community organisations and faith-based groups, work with law enforcement agencies to minimise harassment, adequate and sustained funding, ease of access for clients, and involvement of injection drug users in advisory bodies and other appropriate structures.
• Prevention Programmes for Sex Workers - Studies have found that sex workers are significantly more likely to use condoms if the establishment where they work actively encourages and promotes condoms and facilitates regular STI check-ups. Active involvement of sex workers in condom use and health coverage programme implementation and monitoring has contributed to the rapid scale-up of services to treat STIs.
• Prevention Programmes for Men Who Have Sex With Men (MSM) - Brazil is one of the rare countries to scale-up prevention programmes for MSM.

The document concludes with recommendations for the following levels of potential prevention policy and action: national governments, donors, multilateral and technical agencies, health care providers, researchers, and civil society.