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PEPFAR Implementation: Progress and Promise
In addition to the interventions described above, PEPFAR is supporting the development of a number of new prevention technologies, such as microbicides (female-controlled chemical barriers to prevent transmission of HIV). The U.S. Global AIDS Initiative, through the National Institutes of Health, supports scaling up for clinical trials of three microbicide candidates as well as the HIV Prevention Trials Network, a worldwide collaborative that develops and tests the safety and efficacy of nonvaccine interventions designed to prevent HIV transmission (OGAC, 2005b).
A variety of other prevention activities are funded under the condoms and other prevention subcategory. For example, PEPFAR is supporting studies of risk reduction associated with male circumcision and of alcohol consumption as a risk factor for HIV transmission in a few of the focus countries. PEPFAR is also supporting the training of clinicians and peer counselors in how to communicate comprehensive ABC-based prevention messages. Workplace prevention programs funded by PEPFAR are focused on the development of workplace strategies and training for how to deal with the personal and potential commercial impacts of HIV/AIDS in the workplace.
Comprehensive and integrated approaches drawing on all components of ABC and targeting specific populations have been shown to be effective in increasing healthy behaviors and decreasing transmission of HIV, especially when integrated with other HIV services, such as counseling and testing, treatment of other sexually transmitted infections, and antiretroviral therapy (ART) (Stanton et al., 1998; Furguson et al., 2004; Bunnell et al., 2006; Riedner et al., 2006). There is, however, little evidence to show that ABC when separated out into its components is as effective as the comprehensive approach (Bollinger et al., 2004).
Examples of condoms and other prevention activities in selected focus countries are presented in Box 4-2.
Information Campaigns and Training
Overall, OGAC has reported reaching more than 140 million people in the 15 focus countries with messages intended to prevent the sexual transmission of HIV, a number that represents over one-fourth of the combined population of more than half a billion people in the focus countries. Of this total, roughly two-thirds of people received abstinence-until-marriage/be faithful messages and roughly one-third received condoms and other prevention messages. PEPFAR has supported the training or retraining of more than 864,000 people for prevention programs related to preventing sexual transmission of HIV. Roughly two-thirds of those trained were trained for abstinence-until-marriage/be faithful programs (OGAC, 2005b, 2006a,b, 2007).