The Lancet
Jul 19, 2014 Volume 384 Number 9939 p207 – 280
http://www.thelancet.com/journals/lancet/issue/current

Transformation of HIV from pandemic to low-endemic levels: a public health approach to combination prevention
Alexandra Jones LLM a, Ide Cremin PhD b, Fareed Abdullah FCPHM(SA) c, Prof John Idoko MD d, Peter Cherutich MPH e, Nduku Kilonzo PhD f, Prof Helen Rees MB BCHIR g, Prof Timothy Hallett PhD b, Kevin O’Reilly PhD h, Florence Koechlin MIA h, Bernhard Schwartlander PhD i, Barbara de Zalduondo PhD j, Susan Kim JD a, Jonathan Jay JD a, Jacqueline Huh BA a, Prof Peter Piot PhD k, Dr Mark Dybul MD a
Summary
Large declines in HIV incidence have been reported since 2001, and scientific advances in HIV prevention provide strong hope to reduce incidence further. Now is the time to replace the quest for so-called silver bullets with a public health approach to combination prevention that understands that risk is not evenly distributed and that effective interventions can vary by risk profile. Different countries have different microepidemics, with very different levels of transmission and risk groups, changing over time. Therefore, focus should be on high-transmission geographies, people at highest risk for HIV, and the package of interventions that are most likely to have the largest effect in each different microepidemic. Building on the backbone of behaviour change, condom use, and medical male circumcision, as well as expanded use of antiretroviral drugs for infected people and pre-exposure prophylaxis for uninfected people at high risk of infection, it is now possible to consider the prospect of what would be one of the most remarkable achievements in the history of public health: reduction of HIV transmission from a pandemic to low-level endemicity.