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Intensifying Prevention: The Only Way to Reverse the Epidemic
Although HIV prevalence appears to be stabilizing globally, the overall impact of AIDS on the global population has not yet reached its peak. The epidemic remains a serious, entrenched health crisis that demands a strong, sustained and evidence-informed response.
In the absence of a cure, prevention is the only hope of reversing AIDS. This will require intensifying the scale and scope of HIV-prevention measures that have been shown to work. A comprehensive HIV prevention package could avert 29 million (or 63 per cent) of the 45 million new infections expected to occur between 2002 and 2010, at an initial total cost of some $4.2 billion annually. Unchecked the epidemic will continue.
Yet the supplies and services - even basic information about how HIV is transmitted - to reduce rates of infection remain out of reach for most of the people who are at risk. Fewer than one person in five who is at risk of HIV has access to the means to prevent infection. Only one in ten people living with HIV has been tested for the virus.
The following principles are crucial to the success of any effective HIV programming:
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Efforts must be based on the promotion, protection and respect of human rights including gender equality.
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Programmes must be differentiated and locally-adapted to the relevant epidemiological, economic, social and cultural contexts.
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Actions must be evidence-informed and investment to expand the evidence base should be strengthened.
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Programmes must be comprehensive in scope.
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Both delivery of existing interventions as well as research and development of new technologies require a long-term and sustained effort.
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HIV prevention programming must be at a coverage, scale and intensity that is enough to make a critical difference.
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Participation of those for whom HIV prevention programmes are planned is critical.
UNFPA's work in HIV prevention is based on principles governing its programming in sexual and reproductive health more generally. Foremost is the promotion, protection and respect for human rights, including gender equality, and freedom from stigma and discrimination.
Meaningful involvement of young people and of people living with HIV in all aspects of programming is essential. Programming must reach out to those underserved populations most at risk and vulnerable. It must be firmly informed by evidence, and respond to the particular characteristics of the local context. Moreover, programmes need to be implemented with a view towards strengthening national capacity and involving communities.
UNFPA advocates for and supports comprehensive and appropriate sexual health education as well as information and education services that clearly explain how sexual transmission of HIV can be averted. Other core HIV-prevention areas of activity for UNFPA include:
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Linking HIV/AIDS with sexual and reproductive health care
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Preventing HIV among young people
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Protecting the sexual and reproductive health of women and girls generally. This includes voluntary testing and counselling in reproductive health care settings, support for women living with HIV, and reducing the risks of mother-to-child transmission of HIV
- Preventing the sexual transmission of HIV, especially through condom programming
Successful HIV treatment reinforces HIV prevention. In particular, it makes voluntary testing and counselling more attractive to key groups that are at special risk (such as sex workers, injecting drug users and men who have sex with men), and others. It also reduces the stigma and discrimination associated with the disease. Computer modelling shows that a response that combines prevention and treatment will have greatest impact in reducing both the number of new infections and AIDS-related deaths. Without treatment opportunities, however, prevention efforts can stall. Likewise, prevention is needed to help keep new infections at bay, and thus to make treatment sustainable. The ultimate goal is universal access to prevention, treatment, care and support. This was affirmed by world leaders at the 2006 High-Level Meeting on AIDS, and called for by 48 African countries in the Maputo Call for Action.
With more than three decades of programme experience addressing sensitive issues such as gender relations and sexuality in various socio-cultural settings, UNFPA is uniquely positioned to address many aspects of HIV prevention. Since most HIV infections are sexually transmitted, UNFPA's focus on sexual and reproductive health provides an appropriate entry point for providing information and services. Interventions can be introduced within the context of youth education, family planning, maternal health or management of sexually transmitted infections.
UNFPA also is a leader in family life and sexual health education targeting adolescents and youth, both in and out of school, and is the lead agency within UNAIDS on condom programming.
At the policy level, UNFPA has expertise in advising governments on access to reproductive health. It is supported in this effort by a strong country presence, and a large network of government and nongovernmental partners. UNFPA also brings a unique understanding of the multisectoral nature of the epidemic at country, regional and global levels. The fund is committed to harmonizing and coordinating prevention activities with its UN partners so that assistance can be delivered most effectively within countries.
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