5.2 HIV prevention based on ARV drugs
Consolidated ARV guidelines, June 2013
5.2.4 Combination HIV prevention
People’s HIV prevention needs change during their lifetime, and a combination approach helps people to access the types of interventions that best suit their needs at different times. Combining approaches may also result in synergies that have greater impact than single interventions alone. Although ARV drugs play a key role in HIV prevention, they should be used in combination with an appropriate mix of the following.
- Other biomedical interventions that reduce HIV risk practices and/or the probability of HIV transmission per contact event, including the following.
- Male and female condoms. Male condoms reduce heterosexual transmission by at least 80% and offer 64% protection in anal sex among men who have sex with men (41), if used consistently and correctly. Fewer data are available for the efficacy of female condoms, but evidence suggests they can have a similar prevention effect (42).
- Needle and syringe programmes are highly associated with a reduction in HIV transmission through injecting drug use (43).
- Opioid substitution therapy with methadone or buprenorphine is the most effective form of treatment for opioid dependence and has the additional benefit of effectively reducing HIV risk behaviour and transmission through injecting drug use. Opioid substitution therapy also provides adherence support to people on ART (44-45).
- Voluntary medical male circumcision reduces acquisition of infection and the risk of acquisition for men by up to 66% and offers significant lifelong protection (4).
- Behavioural interventions reduce the frequency of potential transmission events, including the following.
- Targeted information and education. Programmes that use various communication approaches – for example, school-based sex education, peer counselling and community-level and interpersonal counselling – to disseminate behavioural messages designed to encourage people to reduce behaviour that increases the risk of HIV and increase the behaviour that is protective (such as safer drug use, delaying sexual debut, reducing the frequency of unprotected sex with multiple partners, using male and female condoms correctly and consistently and knowing your and your partner’s HIV status).
- Structural and supportive interventions affect access to, uptake of and adherence to behavioural and biomedical interventions. Such interventions address the critical social, legal, political and environmental enablers that contribute to HIV transmission, including legal and policy reform, measures to reduce stigma and discrimination, the promotion of gender equality and prevention of gender-based violence, economic empowerment, access to schooling and supportive interventions designed to enhance referrals, adherence, retention and community mobilization.