Special issue on: The importance of prevention

We are living in an era where new HIV infections are 100% preventable. During the past decade, prevention science has made significant gains developing biological approaches, such as pre-exposure prophylaxis (PrEP) and microbicides, that reduce the risk for contracting HIV. In addition, more effective antiretroviral treatments (ARTs) have significantly extended the lives of persons infected with HIV and reduced the odds of onward infections.

Curtailing the spread of new HIV infections requires a combination of prevention and intervention approaches reflected by consistent condom use and other safer sex behaviors, appropriate perinatal care for HIV-positive mothers, regular testing, and, for persons who are positive, engagement in ART treatment and retention to care. At the core of these multidimensional approaches remains primary prevention and testing. Consequently, the articles in this volume highlight the importance of primary prevention as a critical component for eliminating the spread of new HIV infections. Special attention is given to vulnerable populations, partly due to structural disadvantage, behavioral risks, and biology, who are at increased vulnerability for contracting the virus. Among such populations are youth, women, substance users, urban populations, racial and sexual minorities, and persons residing in low-resourced regions, with many of these identities intersecting.

Bonar et al. focuses much-needed attention on the prevalence and correlates of HIV risk among adolescents and young adults reporting drug use recruited from a U.S. emergency department. This article reminds readers that lack of access to regular health care is a social driver of new HIV infections. Yet with another focus on emerging adults, Harrison et al. tackles the importance of tailoring HIV prevention approaches based on the gender-specific needs of adolescents attending school in KwaZulu-Natal, South Africa. Consequently, the Mpondombili Pilot Intervention illuminates the importance of taking culture into consideration while addressing gender and power dynamics in intimate relationships.

Without question, schools can reach a broad cross section of youth and can be important contexts for delivering comprehensive HIV primary prevention messages. However, school cultures often differ widely based on public or parochial status and adding to such complexities is the critical element of parent–child communication about abstinence and safer sex messages. We are grateful that Cederbaum and Hutchinson explore the important dynamic of parental communication about sex in parochial school families.

Young men who have sex with men (YMSM) and transgendered populations bear some of the highest HIV burdens (Millett et al., 2012). We are thankful that Galvan and colleagues remind readers that despite the important biological advances made with prevention and intervention approaches, routine testing remains a critical component in the HIV care continuum. By discussing a comparison of HIV testing protocols with Latino day laborers, Galvan and colleagues focus our attention on the intersecting identities of ethnicity and social class.

Women who experience gender-based violence are at higher risk for contracting HIV partly because they are unable to effectively negotiate condom use due to the threat of violence (Wu, El-Bassel, Witte, Gilbert, & Chang, 2003). Wendlandt and colleagues provide a fascinating qualitative insight into such dynamics and offers several important implications for social service delivery.

Few studies focus on the complex challenges and structural disadvantages commonly experienced by transgendered populations. Cotten and Garofalo break this silence and in “Project Life Skills” discuss the evolution of developing a much-needed multidimensional HIV-prevention curriculum for young transgendered females. Hopefully, this study would inspire more research among this important and often neglected population.

Also in this issue, Maina and colleagues undertake a systemic review of best practices in HIV care. This article fills a significant gap in extant literature given that such few systematic reviews exist.

In concluding, we hope that readers will come away with a clearer understanding that primary prevention, which is less costly than secondary approaches, is a critical strategy for eliminating new HIV infections. More importantly, readers should comprehend that with culturally and population-specific primary prevention approaches, we have the collective knowledge and capacity to eliminate new infections.