Combination prevention was described in a 2008 Lancet series on HIV prevention as how biomedical, behavioural, and structural interventions could be paired with leadership, community involvement, and social justice to create “highly active HIV prevention.”
Within two years, the approach was adopted by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the United Nations Programme on HIV/AIDS (UNAIDS). It has since been implemented with great success in Uganda, Thailand, Brazil, the Dominican Republic, India, and Rwanda.
In Canada, however, progress on implementing combination prevention of HIV has been mixed and uneven, particularly for gay and bisexual men. Gay and bisexual men continue to make up around half of new infections each year, and are estimated to be 131 times more likely to be HIV-positive than men who do not have sex with men. While combination prevention has been effective in reducing HIV rates among some key populations, such as people who inject drugs, rates remain high among gay and bisexual men.
Achieving similar HIV prevention success among gay and bisexual men requires expanding the range and scope of combination prevention strategies. Our current approach relies heavily on biomedical interventions which are highly efficacious. However, these interventions have the greatest impact when complemented with behavioural and structural interventions, which help ensure that HIV prevention knowledge, tools, and services reach communities effectively and equitably.