Preventive measures against HIV/AIDS

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Extract from the article: HIV/AIDS remains a global health threat. Despite considerable progress in treatment and prevention, new infections are stagnating in several regions and inequalities are hindering access to interventions. There are now multiple prevention stra....

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HIV/AIDS remains a global health threat. Despite considerable progress in treatment and prevention, new infections are stagnating in several regions and inequalities are hindering access to interventions. There are now multiple prevention strategies, including biomedical, behavioral, and structural approaches. These strategies must be implemented in combination, with a focus on rights and equity. What are the preventive measures for combating HIV?

Effective prevention is based on three complementary pillars: reducing exposure (behavioral and risk reduction measures), reducing the likelihood of infection after exposure (biomedical measures: PrEP, condoms), and reducing transmission from people living with HIV (antiretroviral treatment and maintaining an undetectable viral load, U=U). PEP, condoms), and reducing transmission from people living with HIV (antiretroviral treatment and maintaining an undetectable viral load, U=U).

These approaches must be accessible, non-stigmatizing, and tailored to at-risk populations (young people, sex workers, men who have sex with men, transgender people, people who inject drugs, people in prison). The UNAIDS 2024 global report warns of current gaps in prevention and the need for stronger political and financial action.

Screening and diagnosis: the gateway to prevention

Screening is a prerequisite for any strategy: early diagnosis, treatment, and offering PrEP to HIV-negative individuals at risk.

Biomedical prevention

Pre-exposure prophylaxis (PrEP): This is the preventive use of antiretroviral drugs by HIV-negative individuals at risk, which greatly reduces the risk of HIV infection when properly prescribed and followed. Formulations include daily tablets, “on-demand” regimens for certain individuals, and long-acting injections (cabotegravir, lenacapavir, and others).

Effectiveness and monitoring: Oral PrEP, taken regularly, can reduce the risk of sexual transmission by up to 99% in people who take it as prescribed; long-acting injections offer a useful alternative for people who have difficulty adhering to daily medication. Programs combine regular HIV testing, counseling, and management of side effects.

Post-exposure prophylaxis (PEP) is a short course of antiretroviral drugs started as soon as possible, ideally within 3 days of possible exposure. Recent WHO guidelines recommend expanding access to PEP, in particular by allowing community dispensing and simplifying the process to reduce delays in initiation.

Condoms and lubricants remain a fundamental, effective, and inexpensive measure for reducing the sexual transmission of HIV and other sexually transmitted infections (STIs).

Treatment as prevention (TasP) and U=U: A person living with HIV who receives effective antiretroviral treatment and maintains an undetectable viral load does not transmit the virus during sexual intercourse (“Undetectable = Untransmittable,” U=U). Rapid initiation of treatment after diagnosis and maintaining adherence are therefore major preventive pillars.

Prevention of mother-to-child transmission (PMTCT): Systematic screening of pregnant women, initiation of antiretroviral therapy (ART) for HIV-positive mothers, and infant feeding counseling are interventions that have greatly reduced vertical transmission when properly implemented.

New developments and technological prospects

Long-acting injections and new preventive antiretrovirals such as injectable cabotegravir or lenacapavir and other long-acting agents represent a major advance for people who have difficulty adhering to daily treatment. The WHO recently recommended expanding access to some of these options, and new agreements provide for wider availability at reduced costs. These innovations could transform prevention if they are accompanied by equitable deployment.

Focus on World AIDS Day

Celebrated every December 1, this global day mobilizes governments, NGOs, media, and communities to highlight the urgency of the response to HIV. The theme for this year's World AIDS Day is “Overcoming disruptions, transforming the AIDS response.” This theme emphasizes human rights, resilience in the face of disruption, and the need to rebuild the response to HIV in times of uncertainty. These campaigns serve to draw attention, mobilize resources, and promote concrete actions (testing, awareness-raising, advocacy).

For national institutions such as the National Council for the Fight Against AIDS in Togo (CNLS Togo) the National Program for the Fight against AIDS, Viral Hepatitis, and STIs (PNLS-HV-IST), World AIDS Day is an opportunity to organize mass screening campaigns, condom distribution, mobilization conferences, and targeted awareness-raising activities (young people, markets, rural communities). World AIDS Day also serves to raise the visibility of people living with HIV and combat stigma.

Raymond DZAKPATA

Source: “UNAIDS -Global AIDS Update 2024: The Urgency of Now.”