Combination HIV Prevention Interventions: The Potential of Integrated Behavioral and Biomedical Approaches

Abstract

Background Combination HIV prevention interventions that integrate efficacious behavioral and biomedical strategies offer the potential to reduce new HIV infections. Purpose We overview the efficacy data for three biomedical HIV prevention approaches: microbicides, pre-exposure prophylaxis (PrEP), and an HIV vaccination, review factors associated with differential acceptability and uptake of these methods, and suggest strategies to optimize the effectiveness and dissemination of combination HIV prevention approaches. Methods A narrative review was conducted highlighting key efficacy data for microbicides, PrEP, and an HIV vaccination and summarizing acceptability data for each of the three biomedical HIV prevention approaches. Recommendations for the integration and dissemination of combined behavioral and biomedical HIV prevention approaches are provided. Results To date, microbicides and an HIV vaccination have demonstrated limited efficacy for the prevention of HIV. However, PrEP has demonstrated efficacy in reducing HIV incident infections. A diverse array of factors influences both hypothetical willingness and actual usage of each biomedical prevention method. Conclusions Strategies to effectively integrate and evaluate combination HIV prevention interventions are urgently needed.

Pre-exposure Prophylaxis Awareness Among Gay and Other Men who have Sex with Men in Vancouver, British Columbia, Canada

“…For HIV-positive MSM, personal and communal sexual altruism were marginally significantly associated with PrEP awareness at the univariable level, but not in the multivariable model. Altruism has been identified as key factor that would help facilitate positive use of and possible integration of PrEP (33). PrEP-aware, HIV-positive MSM were more likely to report asking their sex partners about their HIV status, which indicates that PrEP may be a lead-in for conversations regarding disclosure.…”

Prevention literacy: community‐based advocacy for access and ownership of the HIV prevention toolkit

“…Recognizing HIV as a biological and social disease, evaluation of prevention efforts outside of trial settings has highlighted that, to be effective, biomedical prevention must be coupled with continual behavioural modification and structural support systems [48,49]. Furthermore, existing HIV prevention strategies have a maximum effect when used in combination with each other and adapted to the needs and contexts of specific populations [3,50,51]. This emphasis on combination prevention has further yielded the metaphor of a HIV prevention toolkit promoted by international agenda-setting organizations, such as UNAIDS [6,7].…”

Re-focusing HIV Prevention Messages: A Qualitative Study in Rural Uganda

“…While global discourse on HIV prevention is emphasizing biomedical approaches (medical male circumcision, treatment as prevention, pre and post exposure prophylactics) for HIV prevention, these approaches do not discount the need for continued behavioral prevention efforts through health education to encourage behavior change [38]. In fact, biomedical approaches can fail if the underlying social and behavioral motivations are not well understood or addressed.…”