A Prevention Revolution: Combination Prevention

From request for proposal; Aids Fonds Keizersgracht 390 1016 GB Amsterdam 6

Most prevention techniques are only partly effective, which means that they do not provide sufficient protection when used on their own. Combination prevention means that, depending on the circumstances, a certain combination of different prevention methods is used. UNAIDS describes combination prevention as follows: "Using the best available research and program experience, combination prevention involves the strategic, coordinated use of different classes of prevention activities -biomedical, behavioural and structural - to design interventions that operate on multiple levels (e.g. individual, relationship, community, societal) and respond to the specific needs and relevant audiences and documented modes of HIV transmission."

HIV prevention approaches can be divided into different classes (10):

Biomedical approaches

Biomedical approaches include circumcision, microbicides, vaccines, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP) and needle exchange. Barrier methods like condoms are biomedical, though programmes to ensure their use are not. HIV treatment can be considered a prevention measure because antiretrovirals reduce people’s infectiousness.

Behavioural approaches

Individual approaches include one-to-one counselling (including voluntary counselling and testing), cognitive behavioural therapy, face-to-face detached or outreach work, telephone helplines and certain internet interventions.

Group approaches are those delivered to small groups of individuals, often from the same peer group, and they are usually facilitated in some way. They include school sex education and small-group work that usually includes both information and risk reduction skills training.

Community interventions are delivered to the whole population or (more frequently) a target audience; the difference from the previous interventions being that individuals do not need to seek out the programme. They include media stories and small-media resources (e.g. leaflets and posters), condom distribution schemes, and some internet interventions like chat rooms.

Structural approaches

Structural interventions which address the drivers of vulnerability such as gender inequality, economic inequality, and lack of social capital.

Sociopolitical interventions include legal change such as the decriminalisation of homosexuality or intravenous drug use; legal sanctions such as the criminalisation of transmission; and policy interventions which may permit other types of prevention work, such as allowing needle exchange.

To maximize the effect of prevention programmes, a combination of the above mentioned prevention interventions should be used, based on the specific needs and context of the target group. Such an approach is called combination prevention (11).