Enhancing HIV prevention requires addressing the complex relationship between prevention and treatment

Abstract

Globally each year, HIV continues to infect millions of people, and the number of people living with HIV and AIDS grows. While there has been an increase in funding for HIV and AIDS, there is a growing gap between the funds available and the funds needed for both prevention and treatment. Yet, one of the means of closing that gap – preventing new infections – has slipped down the agenda. In arguing for a significant intensification of the HIV prevention response, and the relevance of a strong social stance within this response, this paper addresses the need to manage finding a balance between prevention and treatment and care. Not only is there not enough being spent on HIV prevention, but also in some instances, the prevention agenda has been hijacked by those who favour morally conservative, but ineffective, HIV prevention strategies. We argue that effective prevention needs to be firmly located within the everyday realities affecting communities and societies, and needs to focus on what is known to work. In particular, we need to move beyond a public health underpinned by neo-liberal notions of agency and individual responsibility to a public health that recognises the collective nature of epidemics, and works with communities and networks to transform social relations. This latter, more ‘social’ public health, is concerned with the social, political and economic factors that produce HIV risk and responses to it. Contrary to what some might suggest, HIV prevention has not failed, rather, governments and donors have failed HIV prevention.

Keywords:

• HIV/AIDS
• prevention funding
• social determinants
• global health

Notes

1. At the end of 2007, UNAIDS released new figures for HIV and AIDS prevalence, incidence, and HIV-associated deaths. These figures were estimated using a different methodology and a different set of assumptions from previous years and therefore, 2007 estimates are difficult to compare with previous year's estimates. The 2007 UNAIDS report notes that, differences between new HIV infection estimates published in 2006, with those published in 2007, are largely due to enhancements in methodology rather than trends in the pandemic itself. New HIV infections are estimated using modelling tools rather than direct assessments. The report also notes that, there is an increasing evidence of some reduction in incidence may be explained by the natural trend of the epidemic.

2. In 2002, the Global HIV Prevention Working Group was established with the backing of the Bill & Melinda Gates Foundation and the Henry J. Kaiser Family Foundation. The aim of the group is to inform decisions on prevention and to advocate for a comprehensive response to HIV/AIDS that integrates care and prevention.