HIV Prevention Works

After 3 decades of fighting HIV in the United States, we now have more prevention tools with proven effectiveness than ever.

Our national investment in HIV prevention has contributed to dramatic reductions in the annual number of new infections since the peak of the epidemic in the mid-1980s, and an overall stabilization of new infections in recent years.¹⁴ Given continued increases in the number of people living with HIV, this stabilization is in itself a sign of progress. Other important signs of progress include dramatic declines in mother-to-child HIV transmission and reductions in new infections among injection drug users and heterosexuals over time.

HIV prevention has also generated substantial economic benefits. For every HIV infection that is prevented, an estimated $360,000 is saved in the cost of providing lifetime HIV treatment, resulting in significant cost-savings for the health care system.¹⁵

Proven HIV Prevention Interventions

Research has led to a growing number of proven, cost-effective approaches to reduce the risk of HIV infection. Many of these approaches can be particularly effective when tailored to address the social, community, financial, and structural factors that place specific groups at risk. In the United States, proven strategies include:

• HIV testing and linkage to care. Testing is a critical component of prevention efforts because when people learn they are infected, research shows that they take steps to protect their own health and prevent HIV transmission to others.¹⁶ Linkage to care helps ensure people living with HIV receive life-saving medical care and treatment, and helps reduce their risk of transmitting HIV. Efforts are underway to expand HIV testing and linkage to care, especially in those populations in which new infections are occurring in high numbers.
• Antiretroviral therapy. Treating people living with HIV early in their infection dramatically reduces the risk of transmitting the virus to others, underscoring the importance of HIV testing and access to medical care and treatment. A recent clinical trial showed that treating people living with HIV early on reduces the risk of transmitting the virus to others by 96 percent.⁴ Treatment is also essential for reducing the risk of transmission from HIV-infected pregnant women to their infants.^17,18
• Access to condoms and sterile syringes. In order for HIV prevention efforts to work, people who are living with, or at risk for, HIV infection need to have access to effective prevention tools. In particular, research has shown that increasing the availability of condoms and sterile syringes is associated with reductions in HIV risk.^19,20
• Prevention programs for people living with HIV and their partners. Individual and small-group interventions have been shown to significantly reduce risk behaviors among people who have been diagnosed with HIV to help ensure they do not transmit the virus to others.²¹ In addition, partner services can reduce the spread of HIV by facilitating the confidential identification and notification of partners who may have been unknowingly exposed to HIV, providing them with HIV testing, and linking them to prevention and care services.^22,23
• Prevention programs for people at high risk of HIV infection. Individual, small-group, and community interventions for people who are at high risk of HIV infection can reduce risk behavior and can play an important role in many comprehensive HIV prevention strategies.²¹
• Substance abuse treatment. Effective substance abuse treatment that helps drug users stop injecting eliminates the risk of HIV transmission through injection drug use.^20,24
• Screening and treatment for other sexually transmitted infections. Many sexually transmitted infections (STIs) increase an individual’s risk of acquiring and transmitting HIV, and STI treatment may reduce HIV viral load.^25-28

Therefore, STI screening and treatment may reduce risk for HIV transmission.

In addition, pre-exposure prophylaxis, or PrEP, is a new prevention intervention in which HIV-uninfected people take a daily dose of antiretroviral medication to lower their chances of acquiring HIV. PrEP has been proven effective among MSM, and CDC has issued interim guidance on its use in this population.^3,29 Other recent studies have shown PrEP to be effective among heterosexual men and women, although important questions remain about which heterosexuals would benefit most.^5,6 In time, PrEP may play an important role in HIV prevention, and work is ongoing to determine how to successfully implement PrEP programs in an efficient and cost-effective manner.