The theme of this year’s World AIDS Day, which was December 1st, was “Know Your Status,” and aimed to support and promote the ambitious “90-90-90” targets of the Joint United Nations Programme on HIV/AIDS (UNAIDS). These targets, set in 2013, aim to reach a threshold at which 90% of people living with HIV know their HIV status; 90% of people who know their HIV-positive status are accessing treatment; and 90% of people on treatment have suppressed viral loads by the year 2020.
The US President’s Emergency Plan for AIDS Relief (PEPFAR) was established in 2003 to respond to the global HIV/AIDS crisis. Since 2014, Dexis has supported USAID’s Global Health Bureau and frontline field missions in the US government’s global fight against HIV/AIDS through the Global Health Program Cycle Improvement Project (GH Pro). Through this work, we’ve had the opportunity to explore and support a number of the groundbreaking approaches to HIV prevention and treatment that are helping reduce HIV rates and improve the lives of people living with HIV. Here are some of the approaches that we’ve found are highly effective:
- Incorporating voluntary medical male circumcision (VMMC) into HIV programming is highly effective in cultures that do not traditionally circumcise boys. Randomized controlled trials in Kenya, Uganda, and South Africa have shown that medical male circumcision reduces the risk of sexual transmission of HIV from women to men by approximately 60%. According to the World Health Organization, 3.4 million new infections would be prevented in high-risk countries if an 80% coverage rate for VMMC were maintained through 2025. In Swaziland, USAID is developing an operational plan for a national VMMC program, adding another key tool to its approach to combatting HIV in Swazi communities. In addition to strengthening VMMC clinical services, this program is linked to other programs that will educate people on the key components of VMMC, as well as adult and pediatric HIV treatment, prevention of mother-to-child transmission, HIV testing, condoms, health information systems, and human resources for health. GH Pro is helping USAID develop this program by capturing and documenting lessons learned related to VMMC in order to make it safer and more scalable.
- Peer-driven HIV testing is another effective HIV prevention and treatment approach for hard to reach groups. This is particularly important in key populations where stigma and social isolation make it especially difficult to reach people who need HIV services. The Central Asian Republics HIV Flagship Project has successfully rolled out new approaches to HIV programming in Central Asia in key populations that include peer-driven HIV testing. GH Pro’s evaluation of this project found that peer-driven HIV testing in community settings has significantly broadened access to testing for people who inject drugs and their sexual partners who rarely seek health services.
- Promoting country ownership of HIV programs is key to ensuring that results are both achievable and sustainable. Through our work with the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative – a $210 million public-private partnership between PEPFAR, the Nike Foundation, and the Bill & Melinda Gates Foundation – we’ve seen that helping national governments identify social and structural barriers to HIV prevention and treatment can significantly improve countries’ HIV response. In Zambia, for example, GH Pro’s DREAMS advisor identified the major factors that predispose adolescent girls and young women to HIV, including child marriage, economic shocks to the family, school drop-out, gender disparities, and gender-based violence, enabling the government to augment their HIV prevention and treatment approach with activities that address these underlying causes of HIV infection.
PEPFAR has saved over 17 million lives through its HIV interventions around the world. Through continuous evaluating, learning, and sharing on what works, we can continue to make progress toward meeting the ambitious targets for controlling – and eventually ending – the HIV pandemic.
The authors are global health and HIV/AIDS experts at GH Pro.
The views expressed in this publication do not necessarily reflect the views of the United Nations, United States Agency for International Development, the Nike Foundation, the Bill & Melinda Gates Foundation, or the United States Government.