Twenty-five years into the global HIV and AIDS epidemic, infection rates remain unacceptably high with the vast majority in sub Saharan Africa. Achieving the Millennium goal on halting and beginning to reverse the global epidemic by 2015 will remain elusive unless we turn the tide of the epidemic by urgently repositioning and intensify prevention efforts to reach as many people as possible.

While in the last few years, we have witnessed an upsurge in political leadership and commitment, resources, and improved HIV programming in the area of care and treatment, the large numbers of new infections reported each year, is a clear indication of the failures and shortcomings of our prevention programmes. Research has shown us that there is no magic bullet to prevent HIV. Countries like Thailand, Brazil and Uganda have demonstrated that a combined a consistent focus on high-risk groups, generalised broad-based prevention awareness campaigns supported by visible political leadership, and policies that address the root cause of vulnerability to HIV and AIDS can reduce the incidence of HIV.

According to UNAIDS and WHO, well targeted prevention efforts can avert an estimated 28 million new infections, while scaling up treatment and prevention scale up will avert 29 million infections and prevention in sub Saharan alone could avert 55% of the 53 million new infections projected for 2003-2020(Stover et. al 2006).

Although the world has at its disposal, a wide array of proven strategies for preventing new-infections, they reach only a fraction of the people in need. Only 4-16% of people at risk have access to effective prevention methods and tools, on the average one in five people who are at risk of HIV have access to effective prevention (UNAIDS, 2006). An example is the current supply of global public sector male condoms, which is less than 50% of the need, while female condoms fall far short of these figure even though women are at a higher risk of contracting HIV. Failure to make proven prevention methods available to all those who need them will always be the biggest failure of this generation of leaders worldwide.

UNAIDS estimates that worldwide spending on prevention needs to increase to 52% of spending worldwide if we are to have any impact on HIV. Sadly in some countries both financial and human resource support for prevention has actually diminished as resources are moved to support treatment programs. Treatment should be viewed as an opportunity to revitalize prevention. As more people seek to know their status, they can be targeted with prevention messages whether they are infected or not. Unfortunately, the majority of people living with HIV are not aware of their status, only 12 % of people who want to be tested are currently able to do so. (UNAIDS et al 2005).

Following of the SADC Regional Think Tank or Prevention, the purpose of this eForum discussion on prevention is to review the evidence related to prevention and initiate conversations among civil society that will push the debate forward. We aim to examine how to practically reposition and intensify prevention initiatives. Decisive action on prevention is needed now by all of us, individually and collectively, as we drive the prevention agenda to the next level. The forum aims provide a platform to encourage all participants to voice their concerns and thoughts about what has been done, what needs to be done now and for the future. Your experience and expertise is invaluable.

We urge all of you to put in your voices and thoughts into this important discussion in the next 6 months. Topics will range from looking at the key drivers of the epidemic, to hot issues like make circumcision and concurrent relationship, prevention and young people, sexually transmitted infections and prevention for positives. At the end of each discussion topic a summary will be compiled and distributed through both SAfAIDS and UNAIDS websites for wider distribution.

Let's join hands to make history and make a difference for someone out there.

Join the prevention eForum and share your experiences and ideas

Lois B. Chingandu,
Executive Director - SAfAIDS