Celum, C. & J.M. Baeten. The Lancet (February 2013), e-publication ahead of print.
The authors provide commentary on advances in HIV prevention, specifically focusing on approaches for serodiscordant couples and other high-risk groups in sub-Saharan Africa. Prevention strategies, e.g., pre-exposure prophylaxis, should be prioritized to highest-risk populations (ensuring linkages to services), and combined with other prevention inventions. HIV prevention should not only target serodiscordant couples; this would be insufficient to reverse the epidemic. While HIV transmission within serodiscordant couples comprises an important portion of HIV incidence, HIV risk from outside partners is another mode of transmission. The authors referred to a modeling study by Bellan et al. (2013) estimating that extra-couple transmissions accounted for 32-65 percent and 10-47 percent of new HIV infections in men and women, respectively. HIV prevention strategies should both target couple-focused activities, e.g., couples HIV testing and counseling, and persons who have partners with HIV-positive or unknown serostatus, while also aiming to reduce extra-couple transmission. Additionally, young women are at high HIV risk before forming a partnership; therefore, continued prevention activities are needed for this group. The authors concluded that evidence-based combination prevention strategies should focus on high-risk groups, including serodiscordant couples, and on achieving high coverage for these groups, to achieve substantial impact on the epidemic.