Shanaube, K., Bock, P. Current HIV/AIDS Reports (June 2015), Vol. 12, Issue 2, pp. 231–237, doi: 10.1007/s11904-015-0262-z.
This review highlighted key drivers of the epidemic in sub-Saharan Africa (SSA) and discussed innovative strategies for the scale-up of effective combination HIV prevention strategies, with a focus on treatment as prevention. While many countries are implementing combination HIV prevention strategies, extreme rates of poverty, combined with weak health systems and health inequalities, and the failure to prioritize HIV prevention among key populations, continue to drive the epidemic. The authors emphasized that while knowing one’s HIV status is the first step in accessing prevention and treatment services, and may positively influence sexual risk behavior, more than half of the people living with HIV in SSA remain undiagnosed. To be effective, interventions addressing behavior change need to be combined with biomedical interventions, such as pre-exposure prophylaxis, voluntary medical male circumcision, and treatment as prevention. The authors emphasized that innovative strategies, such as home-based HIV testing and counseling, could lead to higher service uptake, especially among men. Treatment strategies that expand access into the community may also enhance linkages. The authors concluded that the SSA context requires multiple strategies to (1) expand knowledge of HIV status, and (2) scale up innovative strategies to increase access to counseling, testing, and treatment. They called for strong community leadership to implement and scale up effective combination prevention programs.