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Political Declaration Target 1 - Sexual Transmission Of HIV
Reduce sexual transmission of HIV by 50% by 2015
Ultimately, HIV prevention is the foundation of the global response to HIV and AIDS. The reductions achieved in new infections amongst adults primarily represent fewer incidences of sexual transmission. This has been achieved by emphasising the need to adopt safer sexual behaviours, such as the use of condoms for protected sex and frequent testing for HIV.
The rate of new HIV infections among adults in low- and middle-income countries is 30 percent lower in 2012 than in 2001. While it is true that the adoption of safer sexual behaviours is a primary reason for this, other factors have helped as well. For example, it has been estimated that if 80% of all adult men in countries with high HIV prevalence took up voluntary medical male circumcision (VMMC), a fifth of new HIV infections could be prevented by 2025.
Increasing the uptake of treatment amongst those who are living with HIV is also a global priority, in order to use treatment as prevention. Antiretroviral therapy (ART) greatly reduces the risk of HIV transmission to sexual partners via unprotected sex, emphasising the importance of universal access to treatment.
However, the 2013 UNAIDS report highlighted that there appeared to be a worrying trend in several countries of social and behavioural change programming receiving a lower priority than is needed. It also emphasised that where programmes exist, they are often uncoordinated with other prevention programmes and are not specifically tailored to address the populations or groups who are most in need.
What still needs to be done?
- Increase investment in condom programming. This would involve supplying more male and female condoms to communities, combining couple’s counselling with condom distribution, and using public health facilities to target condom distribution to specific vulnerable groups who are most at risk of contracting HIV, such as men who have sex with men (MSM) and sex workers. Key to this is maintaining access, consistency and reliability of supply.
- Improve access to HIV & sexual health services, and HIV & sex education amongst young people under 25 years of age. Cash transfer programmes, which would provide financial incentives for young people to adopt safer sexual behaviours, could help to reduce new HIV infections. Further research into this is recommended.
- Scale-up of VMMC. The report recommends that countries look into what would help build demand for circumcision. Current programmes have been successful in reaching males younger than 25 years, but more effort is needed to reach 25-29 year olds. In addition to this, international pressure should continue to identify VMMC as a national priority in those countries who have not already done so.
- Increase focus on providing HIV prevention services for sex workers. This would largely involve increased funding for prevention programming for sex workers. The level of national resources allocated for such programmes by governments tends to be very low, so an increase in the amount of domestic funding, as opposed to international funding, is desirable.
- Increase focus on providing HIV prevention services for men who have sex with men (MSM). It is estimated that globally one in ten MSM lack access to basic HIV prevention interventions. These would include culturally sensitive counselling, testing, therapy, education and sexual risk reduction. More domestic spending on specific programmes for MSM is needed.
- Implement programmes aimed at reducing stigma and increasing sensitivity, largely focussing on legal and rights services, stigma reduction, sensitization of police and the training of health care workers.
- We are not currently on track to meet this target: increased momentum is needed.
- This momentum would require the scale-up of prevention programmes targeting vulnerable groups, and linkages to treatment.