Background There are 34 million people living with HIV globally, and 2.5 million people become newly infected last year. Although there have been some successes in prevention, the epidemic continues unabated in many populations, requiring more intensive and integrated behaviour and biomedical prevention programmes if we are to control HIV spread.
Methods A comprehensive review of randomised trials of behavioural and biomedical interventions aimed at decreasing HIV transmission and acquisition was performed and will be presented.
Results In addition to male circumcision, the most successful biomedical intervention has been the use of antiretroviral drugs (ARVs) for prevention of HIV perinatal transmission and sexual transmission among HIV discordant couples, and for the prevention of HIV acquisition via microbicides and oral pre-exposure prophylaxis (PrEP). All of the transmission studies have demonstrated that reductions in viral load with ARVs to undetectable viral blood levels during birth, breast-feeding, or sexual intercourse reduces transmission by > 96%. This has been the greatest success in the HIV prevention field over the past two decades and continual scale-up of access to ARVs can be associated with marked reductions in HIV transmission and incidence. Decreasing acquisition with use of ARVs is totally dependent on high adherence (> 90%) to the medications in an uninfected population. Studies have had mixed results with some populations with high adherence demonstrating high efficacy using PrEP (> 70% efficacy) or microbicide (> 50% efficacy), while others with low adherence as measured by non-detectable blood levels of ARVs demonstrated no efficacy.
Conclusion Multiple studies have confirmed that effective use of ARVs substantially reduces transmission and emphasise the critical importance of integrated behavioural and biomedical strategies. When treatment with ARVs is combined with other interventions involving voluntary counselling and testing, condoms, adherence to medications, and circumcision, the possibility of controlling HIV becomes a feasible and achievable goal.