This series of briefs, published by Joint United Nations Programme on HIV/AIDS (UNAIDS), is designed to offer an overview of the key interventions needed as part of a combination prevention approach in the countries of Eastern and Southern Africa with high HIV prevalence. The briefs focus on the following 4 areas: modes of transmission, multiple concurrent partnerships, vulnerabilities of women and girls, and male circumcision. Each brief offers background information, outlines challenges to scaling-up within a combination prevention approach, and offers recommendations for action.

According to UNAIDS, combination prevention in Eastern and Southern Africa asserts the importance of combining a number of proven social and medical approaches to achieve maximum impact on HIV prevention. Coordinated evidence-informed strategies that work in concert towards shared prevention goals in the context of a well researched and understood local epidemic will have the best chance of success. Resources and efforts should prioritise these approaches rather than those for which evidence of impact is weak. The starting point is sound analysis of what is driving the epidemic in different contexts - modes of transmission modeling and other "know your epidemic", "know the evidence", and "know your responses" synthesis reviews.

In the context of hyper-endemic and highly generalised epidemics, two factors stand out as critical drivers: multiple concurrent partnerships including age-disparate sex, with low condom use; and lack of male circumcision. On the other hand, in concentrated epidemics, most transmission takes place within the key populations of sex workers and their clients, men having sex with men including prison populations and, to a much smaller but growing extent in this region, injection drug use.

Interventions therefore need to be appropriate to the epidemic context and address the right population groups with the most effective combination of strategies. This means prioritising for scale up, quality delivery and close monitoring and evaluation of those with the greatest likelihood of success: depending on epidemic context, these include socio-cultural and behavioural communication strategies to change norms and behaviours around sexual partnerships; providing safe male circumcision in the context of wider sexual and reproductive health services; strategic condom programming; raising realistic risk perceptions and awareness; and ensuring availability and uptake of PMTCT services.

The following briefs are available for download in PDF format:

UNAIDS website on November 17 2008.