Effective HIV Prevention: A Multi-Pronged Approach
HIV prevention has many differing health promotion methodologies from condom use to regular testing and over the years the focus has shifted from one to another. More recently however there has been an emphasis on utilising multi-pronged risk reduction techniques together, in unison, in order to generate a truly rounded HIV prevention strategy.
In 2014 UNAIDS set the “90-90-90” targets for 2020;
- Get 90% of people living with HIV knowing their status,
- 90% of people living with HIV on antiretroviral therapy (ART)and
- 90% of people living with HIV on ART to an undetectable viral load.
In order to achieve this, education is paramount meaning more work around HIV awareness in community settings. This is especially important work that needs to be done with General Practitioners (GP’s) and other medical staff in particular who may not prioritise an HIV test because they misinterpret the signs of sero-conversion illness. The more people know and understand about HIV and how it works, the better placed they are to protect themselves, protect others and understand the importance of regular testing.
Risk reduction could be defined as working with an individual to identify their risky behaviours and to work with them to reduce the risk from those behaviours not only to themselves but also to other people.
Prevention work, when being done with an individual or group, can include information on condom use, a condom demonstration, a discussion about condom variations, safer sex techniques and information about access to PEP as part of its content. This means the better informed those individuals will be about protection and prevention and the more power they will have to look after themselves and others.
Also key to improving the health and well-being of the community is media. Thorough strategies such as advertising within the community and online the availability of PEP, HIV testing services, HIV and sexual health organisations and HIV awareness workshops or training sessions will help to reduce isolation, stigma and improve accessibility. The more people know about local services the easier they will be to locate and access.
The issue of late diagnosis is now a key message that HIV and sexual health organisations cover in their strategies and prevention work. Late diagnosis can have dire implications on a person’s longer term health and well-being and with a 10x greater risk of death within the first year of diagnosis, it is imperative that HIV testing is threaded through all HIV educational settings to ensure that a person understands key risk factors and the benefits of knowing their diagnosis.
When looking at HIV prevention strategies we must factor in the current drive to get 90% of everyone living with HIV on ART and get their viral load to an undetectable level by 2020. The Swiss Statement in 2008 stated that a person who has been on ART and who’s viral load is undetectable with no other sexually transmitted infections (STIs) for over 6 months and who is adhering well to ART has little chance of transmitting the virus to anyone else. Looking through recent data shows that if the strict guidelines mentioned in the statement are followed then there is but a 4% chance of transmission. This shows the importance of getting people on ART and adhering to their treatment.
Only through combining all of the above mentioned methodologies will an effective HIV prevention strategy be created. All the work compliments each other and when used by multiple agencies within the local community the creation of a multi-agency, multi-pronged HIV prevention structure means that those at risk within the community will ultimately benefit.