Advances, promises, and challenges in HIV prevention

Abstract

As there are over two million new HIV infections each year, there is a critical need for effective HIV prevention strategies. Over the past 3 decades, studies have tested the efficacy of numerous biomedical prevention interventions that have been developed to complement existing behavioral strategies. Until recently, few of these interventions were sufficiently efficacious to merit broad implementation. However, over the past several years, groundbreaking studies have demonstrated the efficacy of several primary and secondary biomedical interventions, which has revitalized the field of HIV prevention. These promising interventions include the administration of antiretroviral medications to high-risk HIV-uninfected persons, known as preexposure prophylaxis, and the early administration of antiretroviral treatment to HIV-infected persons to reduce their infectiousness, a strategy referred to as Treatment as Prevention. Voluntary medical male circumcision represents an additional prevention intervention that has been demonstrated to be efficacious and is undergoing scale-up in several regions with generalized HIV epidemics. However, each of these promising interventions faces barriers to achieving optimal effectiveness, such as substantial adherence challenges resulting in conflicting efficacy results for preexposure prophylaxis, structural challenges with scaling-up antiretroviral therapy for Treatment as Prevention, and cultural challenges in increasing male circumcision uptake in communities where the practice has not been normative. If these challenges can be overcome through scientific creativity, perseverance, and political will, a combination of promising biomedical and behavioral interventions could help curb the HIV epidemic.