New Prevention Technologies (NPTs) are a range of biomedical HIV prevention strategies that have recently been approved or are in the process of being tested for their ability to reduce HIV transmission. These include AIDS vaccines, pre-exposure prophylaxis (PrEP), microbicides, male circumcision, and treatment as prevention.
Vaccines: An AIDS vaccine is an experimental strategy that aims to teach the body's immune system how to fight HIV to reduce the risk of infection or to reduce viral load in those who get the vaccine and go on to become infected. All of the candidate vaccines being studied are experimental; there are no effective AIDS vaccines available today.
Pre-Exposure Prophylaxis (PrEP): PrEP is an experimental approach that uses antiretroviral medications (ARVs) to reduce the risk of HIV infection in HIV-negative people. During a study of gay men, transgender women and other men who have sex with men, a daily pill reduced the risk of HIV by 44%. Additional studies are ongoing in other populations. PrEP is not yet recommended for use.
Note: PrEP must not be confused with post-exposure prophylaxis (PEP), which is available in the UK following exposure to HIV.
Microbicides: The term microbicide refers to various strategies being tested that may reduce the risk of HIV transmission during sex. These include creams, gels, and suppositories that could be used vaginally or rectally. The large majority of microbicide candidates in testing today are formulated with antiretroviral (ARV) drugs. There is now proof of concept that a topical gel can reduce women’s risk of acquiring HIV during vaginal sex. However, more research is needed before such gels are available.
Male circumcision: Medical male circumcision (MMC) is the removal of all or part of the foreskin of the penis by a trained health professional. The term medical male circumcision differentiates circumcision that is performed by a trained health professional from traditional circumcision, which is performed as part of a religious ritual or cultural rite of passage. Adult medical male circumcision can reduce men’s acquisition of HIV by up to 65% when they have vaginal intercourse. However, there is no evidence that it also protects the female partners of men who are HIV positive and it remains unclear whether circumcision could have an impact on HIV transmission among gay men and other men who have sex with men.
Treatment as prevention: Treatment as prevention is a term describing the use of antiretroviral drugs that are used to reduce the risk of passing HIV to others. The strategy would function as a secondary benefit of antiretroviral treatment after its primary purpose of improving an individual’s health. The rationale for this approach is that ARVs reduce viral load. Higher viral loads have been linked to increased risk of passing HIV to sexual partners.
Treatment as prevention is an emerging area and there are different terms and phrases used to describe this approach, including "test and treat" and "testing and linkage to care plus" which recognizes that voluntary HIV testing and diagnosis is the first step to accessing care.
Sperm Washing: Sperm washing is a technique developed for couples who wish to conceive a child, where the male partner is living with HIV and the female partner is not. By isolating sperm from any elements in semen which may contain HIV, the risk of transmission of HIV to the female partner and subsequently her child is greatly reduced. A variety of assisted reproduction techniques can be used to fertilise the female partner with the washed sperm. Numerous observational studies have shown that sperm washing has not resulted in any seroconversions when correctly performed, and it is currently considered the safest method for serodiscodant couples wishing to conceive a child together.
Sperm washing is available in the UK, however its availability is limited to two clinics and the dramatic variability of funding available throughout the country coupled with significant costs is a barrier for many couples.
Why are new prevention technologies important?
HIV infections continue to rise in the UK. Globally, for every person starting treatment, two more become HIV positive. There is an urgent need to expand access to proven prevention methods, including clean needles, female and male condoms, risk reduction counselling, treatment of sexually transmitted infections, and other strategies.
Each new HIV prevention technology presents the possibility of a new option for individuals to help reduce their risk of HIV. None of these interventions on their own can end the epidemic. However, the new strategies being tested today could be powerful additions to the existing toolbox of proven prevention strategies.
The need for further research and development
Funding for research into new prevention options is chronically low. As a result, the pace of development is slower than it needs to be. With sufficient investment, these new tools have the potential to control and bring an end to the HIV pandemic.
The UK African Microbicides Working Group
AHPN hosts the UK African Microbicides Working Group established in 2004 as part of the UK campaign for Microbicides. It is a group of individuals from different HIV organisations in the UK including health promotion specialists, treatment activists and policy officers. The aim of the group is to ensure that the interests of African people/ communities in relation to Microbicides and other new prevention options and strategies (NPTs) including vaccines, pre-exposure prophylaxis (PrEP) and treatment as prevention are protected and the rights and interests of trial participants, users and communities are fully represented and presented. This is done through raising awareness, fostering dialogue with scientists on current developments, gathering views and experiences of our communities to develop positions and inform policy.
For further information please email. Jacqueline.stevenson@ahpn.org.
Useful links
AVAC: Global Advocacy for HIV Prevention
Microbicides Trials Network
International Rectal Microbicides Advocates
International Partnership for Microbicides
Universal Access to Female Condoms
File Gallery
16085African in....pdfDeveloping innovative strategies for HIV prevention
Pittsburgh Post....pdfLeading the way - Faith Leaders talk microbicides