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HIV-prevention science at a crossroads: advances in reducing sexual risk

Vermund, Sten Ha; Allen, Katherine La; Karim, Quarraisha Abdoolb,c

Current Opinion in HIV and AIDS: July 2009 - Volume 4 - Issue 4 - p 266–273
doi: 10.1097/COH.0b013e32832c91dd
Epidemiology: Edited by Tim Mastro and Quarraisha Abdool-Karim

Purpose of review We review the current state of evidence-based prevention strategies for reducing sexual transmission of HIV. The combined programmatic and scientific efforts through 2008 to reduce sexual transmission of HIV have failed to reduce substantially the global pandemic.

Recent findings Prevention interventions to reduce HIV infection target behavioral, biomedical, and structural risk factors. Some of these prevention strategies have been evaluated in randomized clinical trials (RCTs) with HIV seroincidence endpoints. When RCTs are not feasible, a variety of observational and quasiexperimental research approaches can provide insight as to program effectiveness of specific strategies. Only five RCTs have demonstrated a notable decrease in sexually acquired HIV incidence. These include the Mwanza study of syndromic management of sexually transmitted diseases and three male circumcision trials in East Africa; a microbicide trial reported in 2009 shows substantial promise for the efficacy of PRO 2000 (0.5% gel).

Summary The combined programmatic and scientific efforts to reduce sexual transmission of HIV have made incremental progress. New prevention tools are needed to stem the continued spread of HIV, though microbicides and vaccines will take many more years to develop, test, and deploy. Combination strategies of existing modalities should be tested to evaluate the potential for more proximate prevention benefits.

aInstitute for Global Health and Department of Pediatrics at Vanderbilt University School of Medicine, Nashville, Tennessee, USA

bDepartment of Public Health and Family Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

cDivision of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA

Correspondence to Sten H. Vermund, MD, PhD, Vanderbilt Institute for Global Health, 2215 Garland Drive (319 Light Hall), Nashville, TN 37232-0242, USA Tel: +1 615 322 9374; fax: +1 615 322 9400; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.