HIV prevention; lessons from community experiences

In the final plenary session of AIDS 2008 Bruno Spire, President of AIDES, France's primary HIV non-governmental organisation identified reducing stigma, combating prevention fatigue, and diversifying HIV testing as key steps to prevent sexual transmission of HIV in concentrated epidemics. Spire proposed a “triple therapy” strategy to combat stigma and discrimination rooted in evidence of stigma’s negative impact on HIV risk reduction.

The strategy includes fighting for better acceptance of people living with HIV (PLHIV), improving laws and policies to protect those most vulnerable to infection, and implementing prevention programmes that incorporate community mobilisation and peer support. He cited examples of female sex worker mobilisation efforts in India, Chile and France, and an initiative to mobilise men who have sex men in Africa, as important examples of this successful strategy.

To combat HIV prevention fatigue, Spire called for pragmatic solutions for those who do not consistently use condoms, including risk reduction programmes adapted to individual and community needs. He pointed to data showing that access to antiretroviral therapy and perceived good health have a positive impact on consistent condom use among people PLHIV.

Spire also emphasised the importance of a variety of HIV testing approaches. This includes routine testing with opt-out options, which Spire said demonstrates higher rates of HIV detection, as well as increased access to voluntary counseling and testing, particularly in community settings (BPNW's rapid testing service currently has a 10 percent HIV positive rate). In addition to facilitating earlier access to care, learning one’s HIV status enables earlier adoption of safer behaviors.

Spire noted that rates of unprotected intercourse are more than 50% lower among those who know their HIV status.