The HIV prevention crisis – increasing knowledge through innovation
With no improvements in HIV knowledge over the last decade, the signalling of a ‘prevention crisis’ by UNAIDS calls for innovation in the response.
Increasing comprehensive knowledge about HIV continues to be a stumbling block in the response – with only very marginal improvements across sub-Saharan Africa in the last decade of treatment scale-up.
“Decades of efforts at the national and international levels have been largely ineffectual in improving HIV knowledge”, say researchers, who report an approximate 1% relative increase per year in the percentage of the general population who possess a comprehensive knowledge of HIV from 2003 to 2015.
Knowledge around HIV is linked to increased knowledge around risk perception and behaviour change, as well as reducing HIV-related stigma. These all, in turn, positively influence HIV testing and counselling uptake, as well as increased uptake of treatment for people living with HIV.
In an analysis published in the Journal of the International AIDS Society (JIAS) this week, a person’s knowledge is considered ‘comprehensive’ if they answered all of these five questions correctly: Can the risk of HIV transmission be reduced by having sex with only one faithful uninfected partner? Can the risk of HIV transmission be reduced by using condoms? Can a healthy-looking person have HIV? Can a person get HIV from mosquito bites? Can a person get HIV by sharing a meal with someone who is infected?
These same questions have been used since 2001 when the UNGASS set an ambitious target to get 95% of people aged 15-24 years worldwide having a comprehensive knowledge of HIV by 2010.
No country on the African continent met this target – with countries reporting knowledge ranges from just 2%, to 77%.
The analysis comprised of 791,186 women and 395,891 men from 33 countries in sub-Saharan Africa and was collected from the Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS) that are conducted every five years across the region.
Only 35% of women and 41% of men had a comprehensive knowledge of HIV in 2015.
‘Miles to go’ – a prevention crisis
What has become increasingly clear over the last few years, is that the potential offered by the array of innovative and exciting biomedical and behavioural approaches to HIV prevention cannot be realised without further investments to improve HIV knowledge.
UNAIDS’ new report, Miles to go—closing gaps, breaking barriers, righting injustices, issues countries with a stark wake-up call.
“There is a prevention crisis. The success in saving lives has not been matched with equal success in reducing new HIV infections. New HIV infections are not falling fast enough,” said UNAIDS Executive Director Michel Sidibé.
Global new HIV infections have declined by just 18% in the past seven years, from 2.2 million in 2010 to 1.8 million in 2017. However, the region most affected by HIV, East and Southern Africa, have much to be proud of with new HIV infections falling by 30% since 2010.
But women and girls, in particular, are being failed. Primary HIV prevention services, such as HIV communications materials and access to sexual and reproductive health services (including contraception, maternal health, gender-based violence and treatment for sexually transmitted infections), are rarely provided on an adequate scale and with sufficient intensity – despite evidence for their effectiveness.
Innovating for knowledge
So how do we increase knowledge about HIV, and particularly for young women and girls?
What we’ve learnt is that knowledge improvements cannot be achieved in isolation, as demonstrated by the lack of improvement over the last ten years. We need to take a step back and think holistically – integrating HIV into wider health services, therefore promoting every opportunity to talk about HIV.
Crucially, innovative interventions are also needed.
“There are still a lot of misconceptions about HIV among young people. Sex is not talked about openly. Young people are given knowledge about sexual and reproductive health, but they are not given knowledge on how to make a decision about sex,” says Selokela Molamodi of She Conquers in South Africa, quoted in the new UNAIDS report.
She Conquers is a South African government-led national campaign aimed at empowering young women and adolescent girls to take responsibility for their health through programmes including keeping girls in school, economic empowerment initiatives, the creation of youth and girls safe spaces, sexual health education, HIV testing services, and so on.
Their approach is one of several wider initiatives to reach young people with HIV information on the continent. MTV Shuga uses the power of mass media to reach young people on platforms they are already using – with research showing evidence of increased knowledge of HIV and decreases in risky behaviours associated with HIV as a result of the programme.
More to Molamodi’s point, Avert’s Young Voices project worked with young people themselves to create a package of interactive information materials on sex, HIV and relationships – designed to promote thinking and discussion around key topics using animations and comics. The aim is to develop skills and self-efficacy to empower young people to make their own decisions.
Whatever the approach, interventions to improve HIV knowledge are not only important for the health of individuals, but vital to the success of achieving blue-sky goals of ending AIDS. They should be thoroughly invested in and integrated into wider health programming.