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passing on HIV to their female partners. That is why male circumcision will be effective at population level, and is recommended where there are high levels of HIV infection and low levels of male circumcision. There are also a number of biomedical interventions in development. At the time this is being written, this includes HIV vaccines and new ART-based protection for individuals, notably pre-exposure prophylaxis (PrEP, or daily pills for HIV-negative people) and microbicides (creams or gels that include anti-AIDS drugs for application in the vagina or rectum). The following table summarises the state of development of the main biomedical HIV prevention interventions that have either been “tried and tested,” or are relatively new, or are not yet available. State of biomedical HIV prevention interventions as of mid-2011 VCT is long-standing. For many people at risk, taking the test for HIV antibody can provoke a lot of anxiety. In practice, VCT reaches many “worried well” who are not at especially high risk but who want to rule out the possibility of being HIV-positive.
Voluntary counselling and testing
VCT does not prevent HIV by itself. It is truly an intervention that should lead to other things, especially treatment for people who get an HIV-positive result. In terms of prevention, VCT can also be a step to follow-up activities, rather than a stand-alone intervention that directly affects risk and prevention on its own. VCT can be particularly important in countries where large numbers of couples include one partner living with HIV and the other partner is HIV-negative. VCT for the couple is promoted in these cases. This is an intervention to help overcome the challenges of disclosing HIV status and to support couples to better protect themselves. Arguably, in most cases there are not sufficient linkages between VCT programmes and quality post-test HIV prevention, including decision-making and practical prevention skills – for both people who test HIV-negative, and people who are informed they are living with HIV.
Prevention of mother-tochild transmission
Since 2001, PMTCT as a prevention approach has included four prongs: 1. Primary prevention of HIV in women of reproductive age 2. Preventing unintended pregnancy in women living with HIV 3. Preventing HIV transmission from mother to child during pregnancy, childbirth or infancy 4. Providing care and support to mothers, their children, and families Prong 3 of PMTCT involves biomedical interventions that can reduce the risk of mother-to-infant transmission from almost 40% to less than 5%. There are still important challenges for scaling up PMTCT. Coverage gaps for prong 3 are often related to the availability of specific elements of care services at different stages: pre-natal, delivery and post-natal. Male partner involvement also plays a role in increasing uptake, and needs to be a stronger focus of regular PMTCT programming.