We can’t treat HIV with just one drug; we need combination therapy. Prevention needs the same approach. Combination prevention means using a wide range of HIV prevention efforts – from structural change to microbicides to education – and customizing a prevention plan for the local HIV situation.
There are a lot of different approaches that can be included in combination prevention. Treating HIV reduces viral load in people living with AIDS. New technology like microbicides can prevent HIV transmission in delivery mechanisms like gels, films, and vaginal rings. Male circumcision helps to reduce transmission of the HIV virus. Preventing mother-child transmission is an important prevention tool.
The positive prevention approach is another weapon in the combination prevention arsenal. It consists of HIV prevention designed from the perspective of people living with AIDS, and centered on their needs. It is a sex-positive approach and it includes providing HIV treatment, working to make sure people understand their risks, and supporting harm-reduction strategies like condom use. It focuses on delaying the progression of HIV and promoting shared responsibility from AIDS prevention.
Reducing the structural factors that cause HIV transmission is the final aspect of combination prevention. This doesn’t lead to immediate impact on HIV rates, but over time amplifies other prevention efforts. Structural approaches can reduce community vulnerability to HIV transmission. Structural factors that lead to HIV transmission include women’s economic dependence on men, violence against women, and harmful societal norms around male-female relationships. Economic empowerment of women can free them from the need to engage in risky sexual behavior; so can protecting them from violence.
Combination prevention is a new way of looking at existing ideas in HIV prevention. Instead of comparing approaches and pitting them against each other for funding, they are combined for greater effectiveness. This might be the change we need.