title: Transformation of HIV from pandemic to low-endemic levels: a public health approach to combination prevention.
abstract: Large declines in HIV incidence have been reported since 2001, and scientific advances in HIV prevention provide strong hope to reduce incidence further. Now is the time to replace the quest for so-called silver bullets with a public health approach to combination prevention that understands that risk is not evenly distributed and that effective interventions can vary by risk profile. Different countries have different microepidemics, with very different levels of transmission and risk groups, changing over time. Therefore, focus should be on high-transmission geographies, people at highest risk for HIV, and the package of interventions that are most likely to have the largest effect in each different microepidemic. Building on the backbone of behaviour change, condom use, and medical male circumcision, as well as expanded use of antiretroviral drugs for infected people and pre-exposure prophylaxis for uninfected people at high risk of infection, it is now possible to consider the prospect of what would be one of the most remarkable achievements in the history of public health: reduction of HIV transmission from a pandemic to low-level endemicity.
authors.affiliation: O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Jones
authors.affiliation: School of Public Health, Imperial College London, London, UK.
authors.forename: Ide
authors.initials: I
authors.lastname: Cremin
authors.affiliation: South Africa National AIDS Council (SANAC), Pretoria, South Africa.
authors.forename: Fareed
authors.initials: F
authors.lastname: Abdullah
authors.affiliation: National Agency for the Control of AIDS, Abuja, Nigeria.
authors.forename: John
authors.initials: J
authors.lastname: Idoko
authors.affiliation: National AIDS/STD Control Programme (NASCOP), Nairobi, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Cherutich
authors.affiliation: Liverpool Voluntary Counselling and Testing, Care and Treatment, Nairobi, Kenya.
authors.forename: Nduku
authors.initials: N
authors.lastname: Kilonzo
authors.affiliation: Wits Reproductive Health and HIV Institute, University of Witwatersrand, Witwatersrand, South Africa.
authors.forename: Helen
authors.initials: H
authors.lastname: Rees
authors.affiliation: School of Public Health, Imperial College London, London, UK.
authors.forename: Timothy
authors.initials: T
authors.lastname: Hallett
authors.affiliation: Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
authors.forename: Kevin
authors.initials: K
authors.lastname: O'Reilly
authors.affiliation: Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
authors.forename: Florence
authors.initials: F
authors.lastname: Koechlin
authors.affiliation: Department of Evidence, Strategy and Results, UNAIDS, Geneva, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schwartlander
authors.affiliation: Office of the Deputy Executive Director for Programme, UNAIDS, Geneva, Switzerland.
authors.forename: Barbara
authors.initials: B
authors.lastname: de Zalduondo
authors.affiliation: O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Kim
authors.affiliation: O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Jay
authors.affiliation: O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Huh
authors.affiliation: Director's Office, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Piot
authors.affiliation: O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA; The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland. Electronic address: mark.dybul@theglobalfund.org.
authors.forename: Mark
authors.initials: M
authors.lastname: Dybul
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control / Q000706:statistics & numerical data; D008297:Male; D058873:Pandemics / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000628:therapy; D011634:Public Health / Q000379:methods*; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents