1. IAS Satellite Session 25th July 2017 Daniel Were, PhD
Making HIV Prevention Work: Defining the Comprehensive HIV Prevention Package
IAS Satellite Session
25th July 2017
Daniel Were, PhD

2. Background
The basic premise of a comprehensive HIV prevention package is both epidemiological, behavioral, and sociocultural.
Knowledge on the drivers of the global, regional, and country-specific epidemics required.
A basic package must be designed around the target population and their specific needs.
Experience has shown that generic interventions are counterproductive.

3. Distribution of New HIV Infections Globally, 2015
Source: UNAIDS special analysis, 2017

4. Distribution of New HIV Infections in Sub-Saharan Africa, 2015
Source: UNAIDS special analysis, 2017

5. Source: UNAIDS special analysis, 2016
Sub-national HIV Incidence among Young Women (15–24) in Eastern and Southern Africa,
Source: UNAIDS special analysis, 2016

6. Drivers of New HIV Infections in Kenya
Account for a third of the hiv burden:
46%
Kenya AIDS Progress Report 2016

7. The Need for a Holistic Approach to Prevention
Most HIV prevention and treatment strategies have focused on the individual level, assuming individuals will defy or overcome social, economic and political constraints.
Need to mitigate both proximal and contributing risk factors for HIV transmission
Inter-governmental, Global
Society
Community, organizations
Social and sexual networks
Individuals
Adapted from a lecture by FR Cleghorn, available at

8. Factors Catalyzing the HIV Epidemic in Sub Saharan Africa

9. Combination Prevention Is Essential
Effective HIV prevention programs require a combination of behavioral, biomedical, and structural interventions.

10. HIV Prevention Scenarios in Kenya
Ministry of Health. Kenya HIV Prevention Revolution Roadmap

11. Basket of Combination Prevention Tools

12. Current Behavioral Interventions
Multiple evidence based behavioral interventions focused on;
Information and raising awareness
Risk perception education
Development of risk avoidance and risk reduction strategies
Increasing self-efficacy
Correct and consistent condom use skills
Substance abuse mitigation

13. What to Prioritize in Behavioral Interventions
Address gaps in current behavioral interventions;
Basic awareness creation
Increase risk perception - risk avoidance and to develop a risk reduction strategy
Increase self-efficacy - to execute the risk reduction strategy through methods such as pre-exposure prophylaxis, correct condom use e.t.c.

14. Current Biomedical Interventions
HIV testing services
Treatment as Prevention
Voluntary medical male circumcision
Pre-exposure prophylaxis
Post-exposure prophylaxis
Male and female condoms
Methadone treatment and needle exchange
Elimination of mother-to-child transmission
Treatment of sexually transmitted infections

15. What to Prioritize in Biomedical Interventions
Focus on the gaps and optimize effective interventions;
HIV testing services - Men and youth
Treatment as Prevention - 90:90:90
Voluntary medical male circumcision - Age pivot
Pre-exposure prophylaxis - High risk populations
Male and female condoms
Methadone treatment and needle exchange - PWID
Treatment of sexually transmitted infections

16. Current and Priority Structural Interventions
Reducing vulnerability and victimization;
Social protection
Mitigating sexual and gender-based violence
Stigma reduction
Economic empowerment
Gender, social and cultural norms change
Human rights protection
Family and social support

17. Considerations for an Appropriate Combination of Prevention Interventions
Oral pre-exposure prophylaxis may be particularly imperative in settings where exposure to risk cannot be avoided.
Voluntary medical male circumcision is needed in generalized hyper endemic settings.
Behavioral interventions are pivotal to the uptake of biomedical interventions.
Mitigating vulnerability is key to sustaining optimal prevention outcomes.

18. Basic Package of Combination Prevention Interventions
AGYW
(18-24 years)
Awareness and risk reduction, HTS, PrEP, contraceptives, addressing vulnerability
Female Sex
Workers
Risk reduction counselling, Condoms, PrEP, STI treatment, Treatment as Prevention, gender based violence
Men who have
sex with men
Risk reduction counselling, PrEP, STI treatment, condoms, Treatment as Prevention, human rights protection
Persons who
Inject Drugs
Risk reduction counselling, Needle exchange and Methadone treatment,

19. Conclusion
Each key and vulnerable population requires a unique basic package of interventions.
Geographic prioritization is essential.
We should offer population-specific choice and delivery of interventions.
Female-controlled methods should be a focal point.