Advancing HIV Prevention Science: The roads from Cape Town

Published: November 14, 2014

Kenneth Mayer
Original Article:

At the recent HIV Research for Prevention 2014 (HIV R4P) conference in Cape Town, South Africa, almost 1400 researchers from around the world came together to discuss advances in biobehavioural HIV prevention science. The rationale for this first-time meeting was that investigators need to understand the latest research findings from a wide array of disciplines, if the most promising approaches to HIV prevention can be transformed into sustained, cohesive responses that will arrest the pandemic.

In the few years since the HPTN 052 trial showed that earlier initiation of antiretroviral therapy for HIV-infected people decreased HIV transmission to their serodiscordant partners, the concept of “treatment as prevention” has been popularised.2 Annualised global HIV incidence has decreased by a third annually since the height of the epidemic from more than 3 million to about 2 million cases per year. Four large community-randomised studies are underway in South Africa, Botswana, Zambia, Kenya, and Uganda to understand the population-level impact of earlier antiretroviral treatment combined with other evidence-based prevention services. However, initial successes have been followed by subsequent increased HIV spread in some populations. Favourable or stable national trends could mask rising HIV incidence in key populations—ie, men who have sex with men (MSM), sex workers, people who inject drugs, vulnerable youth—often due to decreased access to services because of stigma and discrimination.5 Despite annual HIV incidence decreasing over the past decade, with several million new infections a year, and with declining mortality among people living with HIV, the epidemic continues to grow. Expansion of treatment is an appropriate aspiration, but research to optimise other prevention approaches remains necessary.

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