While global prevalence of HIV infection (percentage of persons infected with HIV) appears to have stabilised in recent years, the global number of people living with HIV is increasing because of ongoing accumulation of new infections with longer survival times, measured over a continuously growing general population.

Across the world, a small but growing number of countries have reduced HIV prevalence through sound prevention efforts. The high rates of transmission of HIV result largely from failure to use the available and effective prevention strategies and tools, and poor coverage of HIV prevention programmes. HIV prevention services were only reaching 20% of people in need in 2005, while coverage for key populations at higher risk of exposure to HIV were considerably lower.

Effective HIV prevention programming focuses on the critical relationships between the epidemiology of HIV infection, the risk behaviours that expose to HIV transmission, and also addresses the collective social and institutional factors, such as sexual norms, gender inequality, and HIV related stigma, that will otherwise continue to fuel HIV epidemic. 

Risk behaviours are enmeshed in complex webs of economic, legal, political, cultural and psychosocial determinants that must be analysed and addressed by policies that are also effectively implemented, and through scaled-up programming.

Comprehensive HIV prevention requires a combination of programmatic and policy actions that promote safer behaviours, reduce vulnerability to transmission, encourage use of key prevention technologies, promote social norms that favor risk reduction and address drivers of the epidemic. 

Effective prevention efforts focus on measures that directly support risk reduction by providing information and skills as well as access to needed commodities (such as condoms, sterile injecting equipment, and drug substitution therapy) for the populations most in need.  In short, national planners and policymakers must: 1) Know their epidemic; and 2) Set priorities accordingly. 

Prevention and treatment must be scaled up in a balanced way, to capitalise fully on synergies between the two.  Comprehensive HIV prevention requires a combination of programmatic interventions and policy actions that promote safer behaviours, reduce biological and social vulnerabilities to transmission, encourage use of key prevention technologies, and promote social norms that favour risk reduction. 

HIV prevention includes addressing an array of issues discussed in other thematic areas in the policy section of the website. Forging links among HIV prevention with related programmes and services such as sexual and reproductive health services and legal services for women, can also contribute to intensification of HIV prevention. Strong linkages as well as special efforts to reach those at higher risk and excluded from access to services will result in more relevant and cost-effective programmes with greater impact.

UNAIDS coordinates its own collective efforts on scaling up prevention, within the ambit of universal access to prevention, care, support and treatment, through building on the comparative advantages of the UNAIDS Cosponsors and Secretariat to support scale up of high quality, comprehensive HIV prevention programmes at all levels. UNAIDS also collaborates with a large number of other stakeholders and promotes and supports the development of strong HIV prevention constituencies. The main focus of UNAIDS on intensification of HIV prevention is at country level as part of its ongoing efforts to support countries to strengthen their overall national responses to the AIDS epidemic.

Essential Policy Actions for HIV Prevention

1. Ensure that human rights are promoted, protected and respected and that measures are taken to eliminate discrimination and combat stigma.
   
2. Build and maintain leadership from all sections of society, including governments, affected communities, nongovernmental organisations, faith-based organisations, the education sector, media, the private sector and trade unions.
   
3. Involve people living with HIV, in the design, implementation and evaluation of prevention strategies, addressing the distinct prevention needs.
   
4. Address cultural norms and beliefs, recognising both the key role they may play in supporting prevention efforts and the potential they have to fuel HIV transmission.
   
5. Promote gender equality and address gender norms and relations to reduce the vulnerability of women and girls, involving men and boys in this effort.
   
6. Promote widespread knowledge and awareness of how HIV is transmitted and how infection can be averted.
   
7. Promote the links between HIV prevention and sexual and reproductive health.
   
8. Support the mobilisation of community-based responses throughout the continuum of prevention, care and treatment.
    
9. Promote programmes targeted at HIV prevention needs of key affected groups and populations.
   
10. Mobilising and strengthening financial, and human and institutional capacity across all sectors, particularly in health and education.
    
11. Review and reform legal frameworks to remove barriers to effective, evidence based HIV prevention, combat stigma and discrimination and protect the rights of people living with HIV or vulnerable or at risk to HIV.
    
12. Ensure that sufficient investments are made in the research and development of, and advocacy for, new prevention technologies.