A new report suggests that 50% of projected HIV infections by 2015 could be prevented if governments and donors increase their HIV expenditure to UNAIDS target levels and implement prevention programmes that have been proven to work.

The Global HIV Prevention Working Group’s report, Bringing HIV Prevention to Scale: An Urgent Global Priority, shows that prevention efforts are not keeping pace with expanding access to antiretroviral therapy. For every person who started effective anti-HIV treatment in 2006, six become newly infected with the virus.

It is estimated that there will be 60 million new HIV infections by 2015, but the report suggests that 30 million of these could be avoided if scientifically proven methods of HIV prevention were implemented.

These measures include treatment to prevent mother-to-child transmission of HIV; testing; prevention efforts targeted at high risk groups, such as men who have sex with men and sex workers; and male circumcision.

However, the working group point to evidence showing that few people who would benefit from HIV prevention have access to it. This includes access to interventions that have been scientifically proven to significantly reduce the risk of HIV transmission, for example:

• Prevention of mother-to-child transmission – in low- and middle-income countries in 2005, only 11% of HIV-positive pregnant women had access to cheap treatment shown to dramatically reduce the risks of vertical transmission.

• HIV testing – only 12% of men and 10% of women in the African countries most seriously affected by HIV had had an HIV test.

• High-risk groups – prevention efforts reached only 9% of men who have sex with men, 8%of injecting drug users, and less than a fifth of sex workers in 2005. Many government still opt for general HIV awareness campaigns rather than initiatives targeted at the groups most at risk of infection.

Although the report suggests that male circumcision could help reduce new HIV infections by 8% by 2015, it warns that no single prevention intervention can be 100% effective.

There has been a significant increase in global HIV spending in recent years, with projected spending in 2007 being $10 billion. However, the working group says that to make a real difference expenditure needs to more than double over the next three years to reach the UNAIDS target of $22 billion by 2010. Effective prevention would account for half of this money.

Membership of the working group includes public health experts, doctors, scientific researchers and people with HIV. It is jointly convened by the Henry J Kaiser Family Foundation and the Bill & Melinda Gates Foundation.

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