Baxter, C., and Karim, S.A. African Journal of AIDS Research (2016), 15(2): 109–121, doi: 10.2989/16085906.2016.1196224.
This review examined combination prevention strategies available for young women in Africa. The authors found some successes, but also numerous challenges:
- Structural and behavioral interventions: Abstinence, monogamy, and condom strategies present numerous behavioral challenges, including partner fidelity, mixed availability of condoms, and agreement on partner condom use. Peer and mass media education, sex education programs, and skills-building projects have improved HIV awareness and condom use and reduced risky behaviors, but have not demonstrated reduced HIV infection rates. HIV counseling and testing have reduced risk-taking behaviors, but stigma and discrimination limit uptake. Cash transfer programs have demonstrated success in school retention, condom use, delayed sexual debut, and reduced sexual risk-taking; but studies have not shown reduced HIV incidence.
- Biomedical interventions: Antimicrobial approaches and pre-exposure prophylaxis have had mixed results, requiring optimal adherence to improve effectiveness. Treatment as prevention is effective; two trials demonstrated zero transmission with viral loads below 400 copies/mL and 200 copies/mL. Although voluntary medical male circumcision reduces female-to-male transmission, it offers little immediate protection for women. Treatment for sexually transmitted infections reduced HIV incidence by 42 percent in one study, but the findings have not been replicated.
The authors concluded that HIV prevention in women requires flexible combination prevention packages that include context- and population-specific biomedical, behavioral, and structural interventions. Further research is needed to identify effective female-controlled prevention strategies.