The decline in AIDS-related deaths, due to an increase in treatment uptake, over recent years has not been matched by successes in prevention, with five new infections for every three people starting treatment. The number of new HIV infections varies widely within and between countries and across different populations.
The international community has committed to achieve universal access to HIV prevention, treatment, care and support, to halt and reverse the spread of HIV and contribute to the achievement of the Millennium Development Goals. This commitment was reinforced in 2011 with the adoption of the Political Declaration on HIV/AIDS: Intensifying our efforts to eliminate HIV/AIDS at the United Nations General Assembly High Level Meeting (HLM) on HIV.
‘Know your epidemic, know your response’ has become accepted as a fundamental approach in the response to AIDS. Central to this is the ability to consider the local context of each epidemic. A breakthrough in global HIV prevention which will send the epidemic into decisive decline will require strategic scaling up of combination approaches, targeted to the epidemiology of specific HIV epidemics.
Combination prevention programmes refer to a portfolio of biomedical, behavioural and structural activities applied in accordance with the epidemiologic and demographic profile and needs of different populations. Combination programmes bring unique challenges both for implementation and evaluation as they entail multi-faceted, context-dependent actions, whose impact is achieved as a result of the mix of programme activities. Simpler and discretely-delivered programmes, for example many biomedical interventions, are often easier to implement and evaluate, than behavioural and structural approaches whose impact may depend on more hard-to-measure variables.