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and Hepatitis.com Coverage of the
XVIII International AIDS Conference (AIDS 2010) July 18 - 23, 2010, Vienna, Austria
Global Experts Call for Better Match between HIV Prevention Efforts and Groups at Greatest Risk
Below is a press release from the group describing the findings. The full Global HIV Prevention Progress Report Card 2010 is available online at www.globalhivprevention.org.
AIDS Experts Warn of Mismatch between
New report card on global HIV prevention urges renewed focus on people at greatest risk
Report card also notes encouraging steps to strengthen prevention being taken by UNAIDS, Global Fund, PEPFAR, and others
Vienna -- July 20, 2010 -- An international panel of AIDS experts warned today that global HIV prevention programs are not having the full impact they could, because they often overlook people at greatest risk of infection, and are not always rigorously planned and managed. Overall, just 10% of countries have HIV prevention programs that are well-matched with national needs.
These are among the findings of a new report card on global HIV prevention released today by the Global HIV Prevention Working Group at the 18th International AIDS Conference. The report card -- which assesses the quality of global HIV prevention efforts against recommendations the Working Group has made over the past decade -- also finds that many countries and donors have begun taking steps to strengthen HIV prevention programs, and urges that these efforts be accelerated.
"The report card's findings should be cause for renewed determination," said Dr. Helene Gayle, co-chair of the Working Group and president and CEO of CARE USA. "We know what works in HIV prevention, and when we bring effective prevention programs to scale, we save lives.
number of countries and donors are already taking important steps to
better match HIV prevention programs with national needs, and there
are clear opportunities for prevention to have far greater impact,"
Dr. Gayle said. "A top priority is to refocus HIV prevention on
people at greatest risk."
"HIV treatment programs have been tremendously effective because they are driven by clear milestones, and progress is carefully monitored," said Dr. Judith Auerbach, Working Group member and vice president for science and public policy at the San Francisco AIDS Foundation. "When prevention programs are evidence-based and rigorously planned, managed, and evaluated, they are highly successful as well."
Report Card Identifies Top Priorities to Use Prevention Resources More Effectively
The new report card is based on a comprehensive analysis of available data on global HIV prevention, including HIV surveillance, service coverage, spending trends, and independent evaluations of prevention programs. From this analysis, Working Group members assigned grades for 31 key indicators of global HIV prevention quality.
On average, grades assigned by the Working Group range from average to poor, with failing grades reported on some indicators, including the availability of timely, accurate data to track rates of new HIV infections in high-risk populations.
The report card includes the following recommendations to ensure that HIV prevention resources are used as effectively as possible (see the report for a complete list):
Match prevention strategies to national needs: National governments and international donors should take immediate steps to refocus HIV prevention programs on the populations at highest risk for becoming infected and infecting others. Advocates and civil society should hold governments and donors accountable for doing so.
In countries with highly concentrated epidemics -- including in Eastern Europe and Central Asia, where HIV is spreading the fastest prevention efforts are most urgently needed among injection drug users, men who have sex with men, and sex workers. Yet in these countries, the Working Group found, less than 5% of total prevention spending is focused on injection drug users, and just 3% is focused on men who have sex with men.
In countries with generalized epidemics, greater focus is needed on preventing new HIV infections among mothers and newborns, and among older couples in stable relationships -- the latter account for a large proportion of new infections but have not been a traditional focus of prevention efforts.
Rapidly scale up cost-effective prevention tools: HIV programs should rapidly scale up cost-effective tools for preventing new infections. For example, only 45% of HIV-infected pregnant women currently receive antiretroviral therapy to prevent mother-to-child HIV transmission, and fewer than 40% of people living with HIV know they are infected, meaning that many people unknowingly transmit the virus to sexual and drug-using partners.
Set clear prevention targets and monitor progress: All countries should have in place clear national prevention plans with specific, time-bound targets. National governments and international donors should report annually on results achieved with HIV prevention spending, and national prevention programs should receive a thorough, independent review at least once every three years.
The Working Group found that only half of countries have established national targets for HIV prevention, and prevention programs are seldom monitored to determine if they are having an impact.
Reform laws to combat HIV discrimination: Discrimination against people affected by HIV impedes effective prevention by increasing stigma and deterring at-risk individuals from seeking prevention services. The one-third of countries that have no HIV anti-discrimination law should immediately adopt one. Countries should also repeal statutes that criminalize HIV transmission and HIV risk behaviors.
Increase funding for HIV prevention: While significant prevention gains can be achieved through better use of existing resources, additional funding for HIV prevention is needed. The Working Group estimates that no more than US$2.9 billion was available for HIV prevention in 2009 -- just 21% of total spending on the epidemic, and less than one-third of the amount UNAIDS says is needed to mount a vigorous, effective prevention response.
Working Group Notes Encouraging New Momentum on HIV Prevention
In releasing the new report card, the Working Group noted encouraging momentum to strengthen HIV prevention, including new commitments to make prevention a greater priority by UNAIDS; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; and PEPFAR. In addition, the Working Group noted that as research finds that treating people with HIV reduces transmission to others, there are new opportunities for treatment programs to also have prevention impact.
The Global HIV Prevention Working Group (www.globalhivprevention.org) is an international panel of more than 50 leading public health experts, clinicians, biomedical and behavioral researchers, advocates, and people affected by HIV/AIDS, convened by the Bill & Melinda Gates Foundation and the Henry J. Kaiser Family Foundation.