The hits, the misses and the possibilities: Strengthening HIV prevention in the SADC region

October 9, 2012 | By Naume Kupe 

We are filling our prevention toolbox and it contains a lot more than condoms. This was one of the take away messages from Scott Kellerman of Management Sciences for Health to participants at the opening of the two-day Southern African Development Community (SADC) HIV Prevention and Research Meeting October 9, 2012.

Program managers and researchers from 14 of the 15 SADC member states spent the day reflecting on recent scientific developments in the HIV and AIDS field and implications for strengthening prevention in the SADC region. They shared experiences and lessons learned in implementing promising interventions in their countries.

Kellerman updated participants on key evidence-based developments presented at the XIX International AIDS Conference, held in Washington, USA in July 2012. Highlights of the hits and good news from recent studies included:

• Research results maintained the effects of medical male circumcision at 65%
• Tenovir the vaginal gel microbicide reduced HIV incidence by 39%, with no serious adverse effects
• The two drug combination pre-exposure prophylaxis (PrEP) showed 44% reduction in HIV acquisition among men who have sex with men and 73% reduction in sero-discordant couples
• Treatment as Prevention (TasP) showed a 96% protective effect among sero-discordant couples (visit www.aids2012 for more on conference presentations).

Country examples presented included the prevention of mother to child transmission program (PMTCT) in Botswana which has achieved a 90% coverage rate, and the Option B+ from Malawi which simplifies the provision of treatment to pregnant women and their babies while preserving the mothers’ health.

Discussions of these interventions in the regional context tempered the excitement generated by the studies, shared experiences, and visions of a full HIV prevention toolbox. Issues raised by the participants included the feasibility of identifying sero-discordant couples in Southern Africa given the prevalence of multiple concurrent partnerships, and promoting male involvement in PMTCT in a social environment that regards childbirth and rearing as women’s work, and policies that deny men paternity leave.

However, the biggest challenges discussed were

• The complexity of selecting the right mix of prevention interventions-biomedical, behavioral and structural, some of which will not be available for a number of years
• Scaling up interventions
• Sustaining interventions in the context of shrinking resources in the region

The results of these important discussions and ways the region can address these complex challenges will be presented with continued discussions at the National AIDS Council meeting and the Health Ministers’ meeting held in November 2012.

The SADC HIV Prevention and Research meeting is supported by Management Sciences for Health (MSH) through funding from USAID.