Comprehensive HIV Prevention

We provide and/or advocate for comprehensive HIV prevention programmes to meet the variety of needs of individuals and communities.

Multiple prevention approaches must be employed in combination in order to support individual behaviour change, influence the social norms regarding risk behaviours and address social, economic, legal and policy barriers to effective prevention. Prevention programmes that ensure that the whole spectrum of prevention options is available to those most at risk, including access to and use of condoms and sterile injecting equipment, have been shown to substantially reduce new HIV infection throughout the world.

We need to provide and/or advocate for a comprehensive range of HIV prevention strategies that includes:

  • accessible and appropriate information about the risks of HIV infection and means of prevention in relation to these risks
  • tailored information, education and communication programmes, including sexual health promotion, counselling, discussion groups and peer support
  • access to and information about the use of commodities for prevention, including male and female condoms and/or sterile injecting equipment
  • social marketing and community education programmes that mobilise communities and influence community norms to support and sustain safer behaviours
  • access to voluntary counselling and testing and treatment, care and support programmes, including prevention of MTCT, and
  • advocacy efforts to address social, economic, legal and cultural barriers to effective HIV prevention.

There is no evidence that single-focus HIV prevention strategies, such as the provision of condoms alone or abstinence-only approaches, are effective in preventing HIV transmission.  Single-focus abstinence programmes, particularly for young people, are a response to concerns that comprehensive sexual health and HIV programmes for young people will hasten sexual debut or lead to promiscuity. However, an analysis of research regarding the impact of sexual health and HIV programming on the age of sexual debut of young people and levels of sexual activity does not bear out these concerns.  An analysis of national-level survey data from Uganda concluded that among the range of interventions employed in that country - including abstinence, delays in sexual debut, reducing the number of sexual partners and increased condom use - increased abstinence by itself may have made the smallest contribution to lowering the risk of HIV transmission.  Interventions had a far greater effect in reducing the number of sexual partners and increasing condom use than they did on the proportion of young people abstaining from sex.

In the context of individual behaviour change, abstinence, fidelity and use of condoms (ABC: Abstinence Be Faithful Condoms) all have a role to play in reducing HIV transmission. However it is critical that abstinence and fidelity are not promoted as the preferred approach, and condoms as a last resort, thereby stigmatising condom use. People vulnerable to HIV infection must have access to the full range of prevention options, provided in a manner that is free of judgement, in order for people to be empowered to assess their own risk and make informed decisions about adopting practices appropriate for them. In relation to sexual behaviour, this may include abstaining from sexual activity, reducing the number of sexual partners, delaying commencement of sexual activity, deciding to be faithful to one partner, accessing treatment for STIs and using condoms to prevent HIV and other STIs. In relation to injecting drug use, this may include abstaining from, stopping or reducing drug use, accessing drug treatment, utilising non-injecting methods of drug use and effective use of sterile injecting equipment.

Furthermore the ABC approach, while promoted as a comprehensive approach to HIV prevention, is focused on individual behaviour alone and does not address the societal factors that shape vulnerability. Fidelity requires the agreement of both people in a relationship and does not take into account previous experience or HIV status of the individuals involved. Where there is unequal power in sexual relationships, women and girls often do not have the power to negotiate condom use. Sexual violence and coercion, both inside and outside marriage, in peacetime and in conflict, increase the threat of HIV infection for women and girls. This underscores the need for a comprehensive approach to HIV prevention that addresses the underlying causes of vulnerability to HIV and its consequences.