Combination Prevention Approaches

Effective HIV prevention responses are comprised of well-targeted and coordinated, multi-level HIV prevention activities. Combination approaches involve simultaneous implementation of several risk-reduction options, along with efforts to increase leadership and political support while engendering community engagement.

Assessment of such multi-component approaches are scientifically challenging and remain to be done, yet “combination approaches” are assumed to have increased effectiveness through the synergies they create between prevention activities and to HIV care, treatment and support activities. Prevention would therefore require:

• A program of behavior change -  A variety of well-targeted behavioral prevention approaches are needed to prevent HIV in a given country or region. Approaches address multiple behaviors, providing individuals with numerous options for reducing their risk, rather than with a single directive. These behavioral prevention activities should be layered, with implementation at the individual, group and community levels.
• Linkages to biomedical strategies - Behavioral strategies are more effective when combined with biomedical prevention approaches such as male circumcision or prevention of mother-to-child transmission.
• Linkages to HIV and AIDS treatment services – Coordination with PMTCT, treatment, care and support programs ensures a continuum of care and a favorable context for prevention programs, in which HIV-negative and HIV-positive individuals receive consistent information and support.
• Activities that promote social justice and human rights - Countries that have successfully reduced HIV transmission can attribute this success to having addressed social and political conditions as well as individual and community-level behaviors.

From a human rights perspective, combination prevention efforts are important and effective by merit of their ability to promote full human and sexual expression. From an epidemiologic perspective, the success of a given combination program in reducing the transmission of HIV will depend on its ability to focus on drivers of HIV transmission in a particular setting, and the relative priority it places on prevention activities according to their effectiveness and reach to affected populations.