HIV Prevention Not Biomedical Not Social Not Behavioral
HIV Prevention (Not Biomedical) (Not Social) (Not Behavioral) JUST PREVENTION Thomas J. Coates Ph. D Michael and Sue Steinberg Professor of Global AIDS Research Director, UCLA Program in Global Health David Geffen School of Medicine University of California Los Angeles
OR Wherefore the relevance of the social sciences?
Prevention Technologies • Voluntary Counseling and Testing for HIV • Couples Counseling and Testing for HIV • Drug Treatment • Syringe Access • Post-exposure Prophylaxis • Treatment of Sexually Transmitted Infections
Prevention Technology Pipeline 2007 2008 2009 2010 2011 HPTN 037 Networks Thailand, USA HPTN 039 HSV-2 Zambia, Zimbabwe, S. Africa, Peru, USA HPTN 043 Stigma S. Africa, Thailand, Tanzania, Zimbabwe, HPTN 058 Opiates Thailand, China HPTN 052 Tx as Prev Thailand, India, Malawi, Zimbabwe, Brazil 2012
Aggleton, 2007
Dowsett, 2007
BARRIER METHODS TREATMENT/ ARV/STI/ ANTIVIRAL HIV Prevention Biomedical Strategies Social Justice and Human Rights Community involvement Leadership & scaling up of treatment/prevention efforts Prevention is Prevention
The Lancet July 21, 2007
Dowsett 2007
Impact on HIV incidence: Evidence from observational studies and RCTs Effect size Study (95% CI) Overall 0. 42 ( 0. 34, 0. 52) High-risk groups 0. 29 ( 0. 20, 0. 42) General Population 0. 56 ( 0. 44, 0. 71) South Africa 0. 40 ( 0. 24, 0. 67) Kenya 0. 41 ( 0. 24, 0. 70) Uganda 0. 49 ( 0. 28, 0. 86) . 15 . 2 . 3 . 4 . 5 1 1. 5 Effect size
The Lancet Feb 24, 2007
Opportunities Ø To re-engage religion Ø To re-energize prevention and promote combination prevention Ø To promote HIV VCT Ø To re-challenge culture (that’s what HIV prevention does) Ø To work on health systems Sawires et al, The Lancet 2007
Padian et al, 2007
Opportunities Ø To engage men and families Ø To contextualize HIV prevention in the broader context of social and reproductive health Ø To re-engage in discussions of power relations Ø To modify the discourse that has branded men as perpetrators of HIV infection Sawires et al, The Lancet 2007
International Human Rights It might be construed as a violation of human rights not to make safe male circumcision accessible to all who need and want it
Resolutions 1. 2. 3. 4. 5. 6. 7. Prevention is prevention All prevention is combination Prevention is counter-cultural Studies are studies Field experiences are field experiences Data are important at all levels Saving lives is the goal
Onto The Future!
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