XIX International AIDS Conference


MOBS01 Prevention Today: What's the Right Mix?
  Bridging Session
Venue: Session Room 1
Time: 23.07.2012, 14:30 - 16:00
Chair: Chris Collins, United States
 
 
This session will explore how policy makers and programme managers can work with the current state of knowledge and unanswered questions about what works in HIV prevention to develop strategic, combination prevention responses. The session will address how to allocate resources most effectively given imperfect knowledge about intervention effectiveness and local and national epidemiology. It will begin with a scientific overview of what we know and do not know followed by a moderated discussion in which three programme planners who have grappled with the challenge of prevention planning will provide concrete examples from a variety of settings. A community based-advocate will provide community perspectives on these choices and the importance of involving community stakeholders in strategic decision-making.
Webcast provided by The Kaiser Family Foundation

14:30
Introduction



14:35
MOBS0101
Powerpoint
Scientific overview


C. Hankins, Netherlands

14:50
MOBS0102
Powerpoint
Moderated discussion


P. Cherutich, Kenya
M. Das, United States
C. Hankins, Netherlands
C. Nawina Nyirenda, Zambia
Z. Wu, China

15:35
Questions and answers



15:55
Conclusion



Powerpoints presentations
Scientific overview - Catherine Hankins

Moderated discussion -



Rapporteur report

Track E report by Joanna Orne-Gliemann


The aim of this bridging session on “Prevention Today: What is the right mix?” was 1) to provide an update on the scientific evidence available to date in the field of HIV prevention, 2) to learn from the experience of programme implementers and community representatives across the world about the challenges in putting prevention into practice.
  • The first panellist presented an overview of what we know and don’t know in HIV prevention science. She described how combination prevention is now the new paradigm: prevention tailored to local needs, combining synergistically biomedical, behavioural and structural tools, engaging affected communities, investing in decentralised and community responses and ensuring flexibility. She reviewed the published results of the most recent trials on prevention technologies, namely on microbicides, male circumcision, pre/post-exposure prophylaxis and treatment as prevention. And highlighted their massive potential for preventing sexual transmission of HIV if widely scaled-up. She mentioned several trials that were currently testing combination prevention in the field. She highlighted the importance for countries to adopt the “know your epidemic, know your response” approach, i.e. tailoring programmes and funds to national needs and privileging prevention tools that work in their country and drop those that don’t.
  • The panellist from Kenya mentioned how challenging it was to introduce new interventions into existing prevention programmes, additional funding needing to be sourced and the overall programme planning rethought. He insisted that current platforms needed to be used to integrate new prevention technologies to avoid creating parallel systems.
  • The San Francisco approach to maximise the continuum of HIV prevention, care and treatment was presented. The panellist described how since 2007 investments in the implementation of effective and efficient HIV interventions were data driven. The efficacy of the approach is being measured based on two indicators: time from HIV diagnosis to virologic suppression and community viral load, both having been dramatically reduced between 2004 and 2009.
  • China’s perspective on HIV prevention was presented as articulated around five major expansions: education, HIV testing, PMTCT, interventions and ART. The panellist emphasised the importance of balance and efficiency when prioritising prevention approaches.
  • The community representative underlined the importance of translating technical language around prevention strategies into simple words for people to understand, adhere and embrace more easily and more sustainably prevention.
During the discussion session, panellists reported on what had been their main challenges and lessons learned when implementing prevention. It was said that the results of the HPTN052 trial were complex to apply at national level: treatment, as efficient as it is, is a very expensive intervention, and convincing decision-makers about the cost-effectiveness in the long term of expanding coverage of ART to reach healthier populations is not easy. It was also acknowledged that implementing the combined HIV prevention paradigm shift takes a long time, mainly because it requires bringing different organisational cultures together with different perspectives of how to implement prevention programmes.
In the audience, a concern was raised about the fact that, with the current emphasis on new prevention technologies, people might become careless and discard condom use. The need to invest in interventions that empower people and raise their self-esteem was mentioned.
Finally, the discussions ended on the issue of funding HIV prevention. In spite of the worldwide economic crises, international AIDS funding has not decreased over the past year and that country funding has increased. Yet the combination HIV prevention revolution does involve high cost interventions and difficult choices will need to be made.

 




   

    The organizers reserve the right to amend the programme.


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