Data shows combination of prevention measures working, but with more elements needed
SEATTLE – As an effective approach to controlling HIV, the value of “combination HIV prevention” is discussed often enough to be known by its initials: CHP. But as always when letters replace words, what they encompass , and if the whole of something called CHP is at least as great as the sum of its parts can be elusive. In Rakai, home to the first cases of HIV reported in Uganda, and the epicenter of the country’s early epidemic, a long-term study has made those questions easier to answer. There, combination prevention continues to mean the interventions known as “behavioral” that include condom use and are spurred by HIV counseling and testing, as well as biomedical prevention measures, that over the last 13 years there have come to include access to antiretroviral treatment for people living with the virus and access to medical circumcision for men who are not infected. At the same time, the data from 30 communities across the district over the 17 years covered by the Rakai Cohort Study includes years before and since the advent of the U.S. President’s Emergency Plan for AIDS Relief and gave researchers the opportunity to track the impacts of those interventions.
Access to treatment as well as to HIV testing and counseling and to condoms increased greatly over the years from start of PEPFAR in 2004 on, and from 2007 on, access to medical circumcision grew as well. At the same time over those years the rate of new HIV infections dropped by 42 percent, while people with viral loads successfully suppressed by antiretroviral treatment grew to 75 percent of those with the virus — a rate representing success by standards set by UNAIDS 90-90-90 goals for testing, treatment, and treatment success.
At the same time self-reported sexual behavior changed little, with the only substantive changes in numbers of partners and of condomless sex acts seen in adolescents, who also reported having sex for the first time at later ages. And, even at a 90-90-90 rate of viral suppression, Mary Grabowski of Johns Hopkins University who presented the findings noted, “incidence remains well above elimination levels.”
That, she added, suggests the need for further interventions, including increased testing outreach for men, added prevention options for women, and improved links to services for people with HIV.