The Global Epidemic (Q Abdool Karim, Section Editor)

Current HIV/AIDS Reports

, Volume 10, Issue 2, pp 169-186

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Combination Prevention: New Hope for Stopping the Epidemic

  • Sten H. VermundAffiliated withVanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt School of Medicine Email author 
  • , Richard J. HayesAffiliated withMRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine


HIV research has identified approaches that can be combined to be more effective in transmission reduction than any 1 modality alone: delayed adolescent sexual debut, mutual monogamy or sexual partner reduction, correct and consistent condom use, pre-exposure prophylaxis with oral antiretroviral drugs or vaginal microbicides, voluntary medical male circumcision, antiretroviral therapy (ART) for prevention (including prevention of mother to child HIV transmission [PMTCT]), treatment of sexually transmitted infections, use of clean needles for all injections, blood screening prior to donation, a future HIV prime/boost vaccine, and the female condom. The extent to which evidence-based modalities can be combined to prevent substantial HIV transmission is largely unknown, but combination approaches that are truly implementable in field conditions are likely to be far more effective than single interventions alone. Analogous to PMTCT, “treatment as prevention” for adult-to-adult transmission reduction includes expanded HIV testing, linkage to care, antiretroviral coverage, retention in care, adherence to therapy, and management of key co-morbidities such as depression and substance use. With successful viral suppression, persons with HIV are far less infectious to others, as we see in the fields of sexually transmitted infection control and mycobacterial disease control (tuberculosis and leprosy). Combination approaches are complex, may involve high program costs, and require substantial global commitments. We present a rationale for such investments and cite an ongoing research agenda that seeks to determine how feasible and cost-effective a combination prevention approach would be in a variety of epidemic contexts, notably that in a sub-Saharan Africa.


HIV Prevention Combination approaches Treatment as prevention Africa Circumcision Behavior change Global epidemic HIV transmission Antiretroviral therapy (ART) Prevention of mother to child HIV transmission (PMTCT) Combination prevention