Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

31 May 2011

Metaphors of HIV Prevention : 1. The HIV Prevention Buffet

via Incidence0, by Roger J. Tatoud

In the very early years of the HIV epidemic, as it was becoming clearer that the virus was mostly sexually transmitted, HIV prevention was limited to promoting condom use. For years, that was all that was available to protect oneself whilst politicians were debating the threat and relevance of this new disease, if they were talking about it at all. Then as the disease spread and a new kind of activism was able to draw more attention to what was becoming an epidemic of epic proportion, it became evident that more needed to be done and from limited, HIV prevention became simple as ABC.

ABC soon revealed its limitations. Abstinence never worked for very long, nor did faithfulness, and as for condom, 30 years of the same repetitive message led to a general fatigue. Still, in 2002, behavioural changes – such as the ABC approache, was accepted as key to understanding and combating the sexual transmission of HIV and confirmed as the way forward for HIV prevention.

Came 2008, when it was finally recognised that ABC was simplistic and was failing to achieve notable and sustainable results. Then, Richard Horton wrote in a Lancet editorial “We need combined prevention, including a portfolio of biomedical, behavioural, and structural interventions”.

Combination Prevention is the new metaphor that will be pervading the field for years to come. But to have substance and impact the approach needs to figure out what to combine. Structural interventions are quite straightforward to identify thought far less to implement (e.g. MSM have finally been recognised as a “most at risk population” at the Mexico AIDS conference in 2006 but progress in addressing their needs is still very slow. Women’s rights have been on the table since the eary 70s, and we still talk about them). Behavioural changes interventions have been extensively explored and implemented in a broad range of situations but with limited success. To date there are very few successful biomedical interventions and none that can compare with condoms when considering efficacy only. But it is believed that expanding the range of interventions will be key to a successful control of the epidemic

From here there are different ways to work out the role of biomedical interventions in Combination Prevention, and the HIV Prevention Buffet metaphor (a.k.a “fast food” metaphor) is one of them. Though there is not much on the menu of the Prevention Buffet, the story goes like this:

Read the rest.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

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