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Accomplishments in HIV prevention science: implications for stemming the epidemic

Abstract

The past two decades have witnessed substantial advances in the science of preventing HIV infection. Although important issues remain and there is a need for continuing research, arguably the biggest challenge in preventing HIV transmission is the full implementation of existing preventive interventions worldwide.

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Figure 1: Global estimates of the HIV/AIDS epidemic in 2001.

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Figure 2: Impact of AIDS on the workforce.

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Figure 3: Condom use and decline in male sexually transmitted diseases (STDs) in Thailand.

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Figure 4: HIV-positive pregnant women receiving ART therapy in Thailand.

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References

  1. Nelson, K.E. et al. Changes in sexual behavior and a decline in HIV infection among young men in Thailand. N. Engl. J. Med. 335, 297–303 (1996).

    Article  CAS  PubMed  Google Scholar 

  2. Kelly, J.A. et al. Randomised, controlled, community-level HIV-prevention intervention for sexual-risk behaviour among homosexual men in US cities. Lancet 350, 1500–1505 (1997).

    Article  CAS  PubMed  Google Scholar 

  3. Holtgrave, D.R. Estimating the effectiveness and efficiency of US HIV prevention efforts using scenario and cost-effectiveness analysis. AIDS 16, 2347–2349 (2002).

    Article  PubMed  Google Scholar 

  4. Cresse, A., Floyd, K., Alban, A. & Guinness, L. Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence. Lancet 359, 1635–1642 (2002).

    Article  Google Scholar 

  5. Joint United Nations Programme on HIV/AIDS (UNAIDS). Report on the global HIV/AIDS epidemic (UNAIDS, Geneva, 2002).

  6. Lamptey, P., Ruckstuhl, K. & Cates, W. The evolving impact of HIV/AIDS on global health. in Dawning Answers: How the HIV/AIDS Epidemic has Helped to Strengthen Public Health (ed. Valdiserri, R.O.) 177–197 (Oxford University Press, Oxford, 2003).

    Google Scholar 

  7. Valdiserri, R.O. et al. AIDS prevention in homosexual and bisexual men: results of a randomized trial evaluating two risk reduction interventions. AIDS 3, 21–26 (1989).

    Article  CAS  PubMed  Google Scholar 

  8. Shain, R.N. et al. A randomized controlled trial of a behavioral intervention to prevent sexually transmitted disease among minority women. N. Engl. J. Med. 340, 93–100 (1999).

    Article  CAS  PubMed  Google Scholar 

  9. Jemmott, J.B., Jemmott, L.S. & Fong, G.T. Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: a randomized controlled trial. J. Am. Med. Assoc. 279 1529–1536 (1998).

    Article  Google Scholar 

  10. Valdiserri, R.O. HIV/AIDS in historical profile. in Dawning Answers: How the HIV/AIDS Epidemic has Helped to Strengthen Public Health (ed. Valdiserri, R.O.) 3–32 (Oxford University Press, Oxford, 2003).

    Google Scholar 

  11. Fox, R., Odaka, N.J., Brookmeyer, R. & Polk, B.F. Effect of HIV antibody disclosure on subsequent sexual activity in homosexual men. AIDS 1, 241–246 (1987).

    CAS  PubMed  Google Scholar 

  12. McCusker, J. et al. Effects of HIV antibody test knowledge on subsequent sexual behaviors in a cohort of homosexually active men. Am. J. Public Health 78, 462–467 (1988).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. van Griensven, G.J.P. et al. Impact of HIV antibody testing on changes in sexual behavior among homosexual men in the Netherlands. Am. J. Public Health 78, 1575–1577 (1988).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Higgins, D.L. et al. Evidence for the effects of HIV antibody counseling and testing on risk behaviors. J. Am. Med. Assoc. 266, 2419–2429 (1991).

    Article  CAS  Google Scholar 

  15. Kamenga, M. et al. Evidence of marked sexual behavior change associated with low HIV-1 seroconversion in 149 married couples with discordant HIV-1 serostatus: experience at an HIV counseling center in Zaire. AIDS 5, 61–67 (1991).

    Article  CAS  PubMed  Google Scholar 

  16. Allen, S. et al. Effect of serotesting with counselling on condom use and seroconversion among HIV discordant couples in Africa. Br. Med. J. 304, 1605–1609 (1992).

    Article  CAS  Google Scholar 

  17. Coates, T.J. et al. Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial. Lancet 356, 103–112 (2000).

    Article  Google Scholar 

  18. Kamb, M.L. et al. Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases. J. Am. Med. Assoc. 280, 1161–1167 (1998).

    Article  CAS  Google Scholar 

  19. Leviton, L. Theoretical foundations of AIDS-prevention programs. in Preventing AIDS: The Design of Effective Programs (ed. Valdiserri, R.O.) 42–90 (Rutgers University Press, New Brunswick, 1989).

    Google Scholar 

  20. Beeker, C. et al. Community-level HIV intervention in 5 cities: final outcome data from the CDC AIDS Community Demonstration Projects. Am. J. Public Health 89, 336–345 (1999).

    Article  Google Scholar 

  21. Merzel, C. & D'Afflitti, J. Reconsidering community-based health promotion: promise, performance, and potential. Am. J. Public Health 93, 557–574 (2003).

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sweat, M.D. & Denison, J.A. Reducing HIV incidence in developing countries with structural and environmental interventions. AIDS 9, S251–S257 (1995).

    PubMed  Google Scholar 

  23. Rojanapithayakorn, W. & Hanenberg, R. The 100% condom program in Thailand. AIDS 10, 1–7 (1996).

    Article  CAS  PubMed  Google Scholar 

  24. Celentano, D.D. et al. Decreasing incidence of HIV and sexually transmitted diseases in young Thai men: evidence for success of the HIV/AIDS control and prevention program. AIDS 12, F29–F36 (1998).

    Article  CAS  PubMed  Google Scholar 

  25. Wasserheit, J. Epidemiological synergy: interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex. Trans. Dis. 19, 61–77 (1992).

    Article  CAS  Google Scholar 

  26. Grosskurth, H. et al. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet 346, 530–536 (1995).

    Article  CAS  PubMed  Google Scholar 

  27. Wawer, M.J. et al. Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial. Lancet 353, 525–535 (1999).

    Article  CAS  PubMed  Google Scholar 

  28. Kamali, A. et al. Syndromic management of sexually transmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: a community randomised trial. Lancet 361, 645–652 (2003).

    Article  CAS  PubMed  Google Scholar 

  29. Korenromp, E.L. et al. HIV dynamics and behaviour change as determinants of the impact of sexually transmitted disease treatment on HIV transmission in the context of the Rakai trial. AIDS 16, 2209–2218 (2002).

    Article  PubMed  Google Scholar 

  30. Hosseinipour, M., Cohen, M.S., Vernazza, P.L. & Kashuba, A.D.M. Can antiretroviral therapy be used to prevent sexual transmission of human immunodeficiency virus type 1? Clin. Infect. Dis. 34, 1391–1395 (2002).

    Article  PubMed  Google Scholar 

  31. Quinn, T.C. et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. N. Engl. J. Med. 342, 921–929 (2000).

    Article  CAS  Google Scholar 

  32. Velasco-Hernandez, J.X., Gershengorn, H.B. & Blower, S.M. Could widespread use of combination antiretroviral therapy eradicate HIV epidemics? Lancet Infect. Dis. 2, 487–493 (2002).

    Article  CAS  PubMed  Google Scholar 

  33. Centers for Disease Control. Management of possible sexual, injecting-drug-use, or other nonoccupational exposure to HIV, including considerations related to antiretroviral therapy. Morbid. Mortal. Wkly. Rep. 47, 1–14 (1998).

  34. Kahn, J.O. et al. Feasibility of postexposure prophylaxis (PEP) against human immunodeficiency virus infection after sexual or injection drug use exposure: the San Francisco PEP study. J. Infect. Dis. 183, 707–714 (2001).

    Article  CAS  PubMed  Google Scholar 

  35. World Health Organization (WHO). Blood safety and clinical technology progress, 2000–2001 (WHO, Geneva, 2002).

  36. Lackritz, E.M. et al. Estimated risk of transmission of the human immunodeficiency virus by screened blood in the United States. N. Engl. J. Med. 333, 1721–1725 (1995).

    Article  CAS  PubMed  Google Scholar 

  37. World Health Organization (WHO). Ensuring blood transfusion safety in Africa (WHO, Geneva, 2001).

  38. Marcus, R., Kay, K. & Mann, J.M. Transmission of human immunodeficiency virus (HIV) in health-care settings worldwide. Bull. World Health Org. 67, 577–582 (1989).

    CAS  PubMed  Google Scholar 

  39. Centers for Disease Control. Recommendations for prevention of HIV transmission in health-care settings. Morbid. Mortal. Wkly. Rep. 36, 3S–18S (1987).

  40. Sagoe-Moses, Pearson, R.D., Perry, J. & Jagger, J. Risks to health care workers in developing countries. N. Engl. J. Med. 345, 538–541 (2001).

    Article  CAS  PubMed  Google Scholar 

  41. World Health Organization (WHO). Position paper on modes of transmission of HIV, with particular references to sub-Saharan Africa and unsafe injections (UNAIDS, Geneva, 2003).

  42. Bell, D.M. Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview. Am. J. Med. 102, 9–15 (1997).

    Article  CAS  PubMed  Google Scholar 

  43. Centers for Disease Control and Prevention. Updated US Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. Morbid. Mortal. Wkly. Rep. 50, 1–52 (2001).

  44. Joint United Nations Programme on HIV/AIDS (UNAIDS). Drug use and HIV/AIDS, fact sheet, United Nations Special Session on HIV/AIDS 2001 (UNAIDS, New York, 1998).

  45. Holtgrave, D.R. et al. An overview of the effectiveness and efficiency of HIV prevention programs. Public Health Rep. 110, 134–146 (1995).

    CAS  PubMed  PubMed Central  Google Scholar 

  46. Wiebel, W.W. et al. Risk behavior and HIV seroincidence among out-of-treatment injection drug users: a four year prospective study. J. Acquired Immune Defic. Syndr. 12, 282–289 (1996).

    Article  CAS  Google Scholar 

  47. Gibson, D.R., Flynn, N.M. & McCarthy, J.J. Effectiveness of methadone treatment in reducing HIV risk behavior and HIV seroconversion among injecting drug users. AIDS 13, 1807–1818 (1999).

    Article  CAS  PubMed  Google Scholar 

  48. Hartel, D.M. & Schoenbaum, E.E. Methadone treatment protects against HIV infection: two decades of experience in the Bronx, New York City. Public Health Rep. 113, 107–115 (1998).

    PubMed  PubMed Central  Google Scholar 

  49. Hurley, S.F., Jolley, D.J. & Kaldor, J.M. Effectiveness of needle-exchange programmes for prevention of HIV infection. Lancet 349, 1797–1800 (1997).

    Article  CAS  PubMed  Google Scholar 

  50. Strathdee, S.A. & Vlahov D. The effectiveness of needle exchange programs: a review of the science and policy. AIDScience 1, 1–13 [online] <http://aidscience.org/Articles/aidscience013.asp> (2001).

    Google Scholar 

  51. Gibson, D.R. Flynn, N.M. & Perales, D. Effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users. AIDS 15, 1329–1341 (2001).

    Article  CAS  PubMed  Google Scholar 

  52. Groseclose, S.L. et al. Impact of increased legal access to needles and syringes on practices of injecting drug users and police officers—Connecticut, 1992–1993. J. Acquired Immune Defic. Syndr. 10, 82–89 (1995).

    CAS  Google Scholar 

  53. Valleroy, L.A. et al. Impact of increased legal access to needles and syringes on community pharmacies' needle and syringe sales—Connecticut, 1992–1993. J. Acquired Immune Defic. Syndr. 10, 73–81 (1995).

    CAS  Google Scholar 

  54. Quinn, T. Global burden of the HIV pandemic. Lancet 348, 99–106 (1996).

    Article  CAS  PubMed  Google Scholar 

  55. Joint United Nations Programme on HIV/AIDS (UNAIDS). AIDS epidemic update (UNAIDS, Geneva, 2002).

  56. Wiktor, S.Z., Ekpini, E. & Nduati, R.W. Prevention of mother-to-child transmission of HIV-1 in Africa. AIDS 11, S79–S87 (1997).

    Article  PubMed  Google Scholar 

  57. Connor, E.M. et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N. Engl. J. Med. 331, 1173–1180 (1994).

    Article  CAS  PubMed  Google Scholar 

  58. Shaffer, N. et al. Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomised controlled trial. Lancet 353, 773–780 (1999).

    Article  CAS  PubMed  Google Scholar 

  59. Wiktor, S.Z. et al. Short-course oral zidovudine for prevention of mother-to-child transmission of HIV-1 in Abidjan, Cote d'Ivoire: a randomised trial. Lancet 353, 781–785 (1999).

    Article  CAS  PubMed  Google Scholar 

  60. Guay, L.A. et al. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet 354, 795–802 (1999).

    Article  CAS  PubMed  Google Scholar 

  61. Leroy, V. et al. International multicentre pooled analysis of late postnatal mother-to-child transmission of HIV-1 infection. Lancet 352, 597–600 (1998).

    Article  CAS  PubMed  Google Scholar 

  62. Nduati, R. et al. Effect of breastfeeding and formula feeding on transmission of HIV-1: a randomized clinical trial. J. Am. Med. Assoc. 283, 1167–1174 (2000).

    Article  CAS  Google Scholar 

  63. Centers for Disease Control. Advancing HIV prevention: new strategies for a changing epidemic–United States. Morbid. Mortal. Wkly. Rep. 52, 329–332 (2003).

  64. Kanshana, S. et al. Implementing short course zidovudine to reduce mother-infant HIV transmission in a large pilot program in Thailand. AIDS 14, 1617–1623 (2000).

    Article  CAS  PubMed  Google Scholar 

  65. Centers for Disease Control. Evaluation of a regional pilot program to prevent mother-infant HIV transmission, Thailand, 1998–2000. Morbid. Mortal. Wkly. Rep. 50, 599–603 (2001).

  66. Amornwichet, P. et al. Preventing mother-to-child HIV transmission: the first year of Thailand's national program. J. Am. Med. Assoc. 288, 245–248 (2002).

    Article  Google Scholar 

  67. Gayle, H.D. Curbing the global AIDS epidemic. N. Engl. J. Med. 348, 1802–1805 (2003).

    Article  PubMed  Google Scholar 

  68. Stover, J. et al. Can we reverse the HIV/AIDS pandemic with an expanded response? Lancet 360, 73–77 (2001).

    Article  Google Scholar 

  69. Schwartlander, B. et al. Resource needs for HIV/AIDS. Science 292, 2434–2436 (2001).

    Article  CAS  PubMed  Google Scholar 

  70. Joint United Nations Programme on HIV/AIDS (UNAIDS). HIV prevention needs and successes: a tale of three countries (UNAIDS, Geneva, 2001).

  71. Berkman, A. Confronting global AIDS: prevention and treatment. Am. J. Public Health 91, 1348–1349 (2001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Valdiserri, R.O. HIV/AIDS stigma: an impediment to public health. Am. J. Public Health 92, 5–6 (2002).

    Article  Google Scholar 

  73. Centers for Disease Control. Primary and secondary syphilis among men who have sex with men–New York City, 2001. Morbid. Mortal. Wkly. Rep. 51, 853–856 (2002).

  74. Janssen, R.S. et al. The serostatus approach to fighting the HIV epidemic: prevention strategies for infected individuals. Am. J. Public Health 91, 1019–1024 (2001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  75. Bond, V., Chase, E. & Aggleton, P. Stigma, HIV/AIDS and prevention of mother-to-child transmission in Zambia. Eval. Program Planning 25, 347–356 (2002).

    Article  Google Scholar 

  76. Global HIV Prevention Working Group. Global Mobilization for HIV Prevention: a blueprint for action (Global HIV Prevention Working Group, Barcelona, 2002).

  77. Hogle, J.A. (ed.) What happened in Uganda: declining HIV prevalence, behavior change, and the national response (US Agency for International Development, Washington, 2002).

    Google Scholar 

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Valdiserri, R., Ogden, L. & McCray, E. Accomplishments in HIV prevention science: implications for stemming the epidemic. Nat Med 9, 881–886 (2003). https://doi.org/10.1038/nm0703-881

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