Governments, communities and scientists must fully implement combination HIV prevention, and the international community must mobilise all the support necessary for this effort. This statement forms part of the call to action in the final paper in The Lancet Series on HIV Prevention, authored by Dr Peter Piot and Michael Bartos, Joint United Nations Programme on HIV AIDS, Geneva, Switzerland, and colleagues.
A quarter of a century of AIDS responses has created vast knowledge about HIV transmission and prevention, yet some 7000 people become infected daily around the world. Essential programmes have not had sufficient funding or coverage, and such programmes have often not been targeted to the populations that need them most. The authors call for confident and unified leadership to overcome the political, cultural, and logistic barriers to effective HIV prevention. This includes mustering support for proven interventions such as the frank education of young people, harm reduction policies for injecting drug use, and including sexual minorities in HIV programmes.
International institutions, national governments, and community activists must work together to build demand for HIV prevention, Support must be rallied in every area possible, including workplaces, schools, communities and places of worship. An active coalition between the movement for HIV prevention and the movement of people living with HIV/AIDS should also be created and linked with other social movements such as treatment activists, entrepreneurs, and women's and youth activists.
The authors urge scientists, research funders, and programme planners to broaden the HIV-prevention research agenda, in particular through a greater focus on operational research to help guide optimum programme scale-up. They also call for continuing the quest for a HIV vaccine and investing in research for any potential HIV-prevention technologies. Investment must also be made in building managerial, technical, and implementation capacity for national HIV/AIDS authorities, allowing them to direct the HIV-prevention response with confidence.
The authors say: "If combination prevention is intensified as rapidly as possible from today, then some 12 million fewer HIV infections will occur if incidence at today's levels remains constant, and the annual number of new infections in 2015 will have reduced by two-thirds." UNAIDS estimates that HIV prevention will cost US $11.6 billion by 2010 and $15.3 billion by 2015 as programmes phase-up to universal access.
They conclude: "None of the successes in HIV prevention over the past quarter of a century have been easily won. They have required taboos to be broken, pleasures foregone, resources reallocated." They add that failing to deliver effective HIV prevention now would be devastating and felt for generations; and that results cannot be expected within one or even two political or funding cycles — the long-haul approach is needed. They say: "We must have the courage to press ahead, because if we fail the challenge of HIV prevention, HIV/AIDS will relentlessly undermine human progress. An energised HIV-prevention movement, marching hand-in-hand with the movement to make access to treatment universal, is a goal truly worth the effort it will take."
Dr Peter Piot, Joint United Nations Programme on HIV AIDS, Geneva, Switzerland (attending conference) T) +41-79 5132230 / Mexico +52 55 1393 0133 E) piotp@unaids.org
Michael Bartos, Joint United Nations Programme on HIV AIDS, Geneva T) +41-79 500 2124 / Mexico + 52 552143 4497 E) bartosm@unaids.org
Alternative contact Mahesh Mahalingam, Media Relations T) +41-79 832 3814 E) maheshm@unaids.org
Please note: a press conference to launch this series will take place at the International AIDS conference on Tuesday 5 August, 1500-1545 (Mexico City time) in Room 1 (Aztecas), Media Centre, Hall A, Level 1, Centro Banamex, Mexico City
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Journal
The Lancet