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UNAIDS and a broad range of partners have collaborated to establish a new set of HIV prevention targets to be achieved by 2025 as an intermediate step towards the sustainable development target for 2030. The number of new HIV infections in the world continues to decline, in part due to the extraordinary expansion of effective HIV treatment. However, the decline is geographically heterogeneous, with some regions reporting a rise in incidence. The incidence target that was agreed for 2020 has been missed. A range of exciting new HIV prevention technologies have become available or are in the pipeline but will only have an impact if they are accessible and affordable and delivered within systems that take full account of the social and political context in which most infections occur. Most new infections occur in populations that are marginalised or discriminated against due to structural, legal, and cultural barriers. The new targets imply a new approach to HIV prevention that emphasises appropriate, person-centred, prioritised, effective, combination HIV prevention within a framework that reduces existing barriers to services and acknowledges heterogeneity, autonomy, and choice. These targets have consequences for people working in HIV programmes both for delivery and for monitoring and evaluation, for health planners setting local and national priorities, and for funders both domestic and global. Most importantly, they have consequences for people who are at risk of HIV exposure and infection. Achieving these targets will have a huge impact on the future of the HIV epidemic and put us back on track towards ending AIDS as a public health threat by 2030., Author(s): Peter Godfrey-Faussett 1,2,*, Luisa Frescura 1, Quarraisha Abdool Karim 3, Michaela Clayton 4, Peter D. Ghys 1,(on behalf of the 2025 prevention targets working group) Introduction Course correction needed [...]

Author(s): Elvin H. Geng 1,*, Michael J. A. Reid 2,3, Eric Goosby 2,3, Quarraisha Abdool-Karim 4,5 Many problems underscored by the Coronavirus Disease 2019 (COVID-19) pandemic, and highlighted in other [...]

The article discusses the progress made towards ending the AIDS epidemic by 2030, as pledged by world leaders in 2015. While significant strides have been made in terms of initiating HIV-positive individuals on antiretroviral medication and reducing AIDS-related deaths, perinatal transmissions, and new acquisitions, challenges remain in ending new acquisitions and eliminating stigma and discrimination. The COVID-19 pandemic has further complicated efforts to achieve these goals. The article emphasizes the need for renewed political commitment, innovative approaches, collaboration, and sustained funding beyond 2030. It also highlights the importance of research for a vaccine and a cure, as well as the development of new antiretroviral drugs and prevention methods. The article acknowledges the achievements of universal access to treatment and prevention of vertical transmission but emphasizes the need to reach pregnant women who do not use prenatal health services. Community involvement, reducing stigma and discrimination, and addressing social determinants of health are also crucial. The article concludes by expressing hope that with unwavering effort, political commitment, and global solidarity, the goals of zero new acquisitions, zero AIDS-related deaths, and zero stigma and discrimination can still be achieved within this decade. [Extracted from the article]

Understanding the sexual relationships of young women is critical for preventing HIV infections. This study aimed to describe the sexual behaviour of partners, comparing the accuracy of sexual health knowledge between partners. The study took place in 2017 in KwaZulu-Natal, South Africa. Purposive sampling was used to select 18–27-year-old sexually active women. Consenting female participants completed a structured and semi-structured interview, while consenting male sexual partners identified through the female participant completed a structured questionnaire on sexual health information. Using a reflexive inductive approach and thematic analysis, we identified key discrepancies in the assumptions partners make about each other's sexual health information. Twenty-three sexual dyads were identified and four key discrepancies were identified: Age: partners either over or underestimated the age of their partners, HIV status: where partners were unaware of, or incorrectly assumed their partner's status, Lack of awareness of partner's concurrent relationships and more general knowledge of the partner's sexual health behaviours. Discussions about sexual health are mediated by relationship length, type of partner, power and perceived fidelity. While it is possible to undertake dyadic level research, ethical tensions remain. Sex-positive and egalitarian sexual health interventions that target the individual, as well as the sexual relationship, are needed. [ABSTRACT FROM AUTHOR]

Background: There are gaps in uptake of, adherence to, and persistence in the use of preexposure prophylaxis for human immunodeficiency virus (HIV) prevention among cisgender women., Methods: We conducted a phase 3, double-blind, randomized, controlled trial involving adolescent girls and young women in South Africa and Uganda. Participants were assigned in a 2:2:1 ratio to receive subcutaneous lenacapavir every 26 weeks, daily oral emtricitabine-tenofovir alafenamide (F/TAF), or daily oral emtricitabine-tenofovir disoproxil fumarate (F/TDF; active control); all participants also received the alternate subcutaneous or oral placebo. We assessed the efficacy of lenacapavir and F/TAF by comparing the incidence of HIV infection with the estimated background incidence in the screened population and evaluated relative efficacy as compared with F/TDF., Results: Among 5338 participants who were initially HIV-negative, 55 incident HIV infections were observed: 0 infections among 2134 participants in the lenacapavir group (0 per 100 person-years; 95% confidence interval [CI], 0.00 to 0.19), 39 infections among 2136 participants in the F/TAF group (2.02 per 100 person-years; 95% CI, 1.44 to 2.76), and 16 infections among 1068 participants in the F/TDF group (1.69 per 100 person-years; 95% CI, 0.96 to 2.74). Background HIV incidence in the screened population (8094 participants) was 2.41 per 100 person-years (95% CI, 1.82 to 3.19). HIV incidence with lenacapavir was significantly lower than background HIV incidence (incidence rate ratio, 0.00; 95% CI, 0.00 to 0.04; P<0.001) and than HIV incidence with F/TDF (incidence rate ratio, 0.00; 95% CI, 0.00 to 0.10; P<0.001). HIV incidence with F/TAF did not differ significantly from background HIV incidence (incidence rate ratio, 0.84; 95% CI, 0.55 to 1.28; P = 0.21), and no evidence of a meaningful difference in HIV incidence was observed between F/TAF and F/TDF (incidence rate ratio, 1.20; 95% CI, 0.67 to 2.14). Adherence to F/TAF and F/TDF was low. No safety concerns were found. Injection-site reactions were more common in the lenacapavir group (68.8%) than in the placebo injection group (F/TAF and F/TDF combined) (34.9%); 4 participants in the lenacapavir group (0.2%) discontinued the trial regimen owing to injection-site reactions., Conclusions: No participants receiving twice-yearly lenacapavir acquired HIV infection. HIV incidence with lenacapavir was significantly lower than background HIV incidence and HIV incidence with F/TDF. (Funded by Gilead Sciences; PURPOSE 1 ClinicalTrials.gov number, NCT04994509.)., (Copyright © 2024 Massachusetts Medical Society.)