Most successful HIV prevention interventions

Uganda has made significant progress in combating the HIV epidemic. HIV prevalence rate was 18 per cent in the 90s but has reduced to 6 per cent currently. There has been a reduction in new infections, peri-natal HIV transmissions and AIDS related deaths.

The current strategy to reduce the incidence of HIV infection in Uganda focuses on a combination of multiple interventions. They include prevention based on strategies on treatment and behavioral change such as abstinence, faithfulness and condom use, safe male circumcision, HIV counselling and testing, elimination of mother-to-child transmission and care and treatment of HIV patients.

According to Dr Charles Wendo, a board member at the Uganda Aids Commission, the 90:90:90 targets imply that at least 90 per cent of all HIV positive persons identified through responsive testing screening; at least 90 per cent of all the identified positive persons enroll on antiretroviral therapy and at least 90 per cent of all persons on HIV treatment adhere to the treatment in order to attain and sustain viral suppression.

PMTCT
Approximately one-third of children born to mothers who are living with HIV will acquire HIV infection in the absence of preventive measures. In 2012, Uganda adopted a new strategy, Prevention of Mother To Child Transmission of HIV (PMTCT).
The intervention prevents transmission of HIV from an HIV-positive mother to her infant during pregnancy, labour, delivery, or breastfeeding. It includes providing appropriate treatment, care, and support to mothers living with HIV and their children and families.

Dr Wendo says, “PMTCT preventive interventions consist of a cascade of services, including HIV testing and counselling, antiretroviral therapy, safe delivery, safer infant feeding and postpartum interventions such as cotrimoxazole prophylaxis, early diagnosis for HIV-exposed infants, and links to treatment and care, as well as standard postpartum child survival interventions.”
Whereas Uganda is on track to meet the global target in eliminating HIV, mother-to-child transmission is still a problem. One of the major barriers to eliminating mother-to-child transmission is limited male involvement.

Viral load suppression
According to Prof Pontiano Kaleebu, the director of Uganda Virus Research Institute (UVRI), effective HIV treatment (antiretroviral therapy) suppresses the amount of HIV in your body fluids to the point where it cannot be detected by the tests used in clinics.
It does mean that, as long as your viral load stays undetectable, you radically reduce your chance of passing HIV on to someone else.

HIV treatment is as effective as consistent condom use in preventing HIV transmission during vaginal sex.”
Having an undetectable viral load does not mean you are cured of HIV. It also does not mean you should stop taking treatment.
“At the time of infection, the viral load is usually very high. Once one is diagnosed with the virus, it is recommendable that they start on ARVs immediately. Viral load suppression cannot happen if the person that is HIV positive does not take the ARVs very well,” Prof Kaleebu remarks.

Condom use
Condoms help prevent transmission by reducing the risk of an exposure to HIV during sex. When used consistently and correctly, condoms are highly effective in preventing HIV.
They are also effective at preventing sexually transmitted diseases (STDs) that are transmitted through bodily fluids, such as gonorrhea and chlamydia.

“Currently, there are both male and female condoms and people that are HIV positive should strictly make use of them. Condoms help to protect people from further infection with an even more resistant strain of HIV. Condoms paired with PrEP or ART, provide even more protection.”
Condoms are most effective when used properly, which includes using one that is the right size.

Male involvement
The presidential handbook on tracking and ending HIV/Aids in Uganda points out male involvement in the prevention and closing the gap on new infections particularly among girls and young women.
About 45 per cent of the HIV infected men have not yet been diagnosed and 48 per cent of the men who are known to be positive have not started treatment.
Dr Wendo says safe male circumcision, as part of prevention for HIV, is thought to have other benefits. It reduces the risk of penile cancer, urinary tract infections and heterosexually acquired HIV infection in men by approximately 60 per cent.