How Do We Implement HIV Prevention on a Broad Scale?

Early detection and treatment prevents transmission of HIV and improves health outcomes for those infected. Research indicates that routine HIV screening in healthcare settings among populations with a prevalence rate as low as 1 percent is as cost effective as screening for other conditions such as breast cancer and high blood pressure. These findings suggest that HIV screening can lower healthcare costs by preventing highrisk practices and decreasing virus transmission.⁴²

More recently, scientists demonstrated⁴³ that providing early HAART therapy to the HIV-infected partner of a heterosexual couple was 96 percent successful in preventing the spread of the virus to the uninfected partner. In fact, early initiation of HAART has been shown to be pivotal in reducing viral load and HIV incidence at the population level.^{44, 45} Capitalizing on these and other findings, researchers and clinicians have been testing and promoting the Seek, Test, Treat, and Retain approach to identify high-risk populations (Seek) including substance abusers and those in the criminal justice system; test them for HIV (Test); initiate HAART for those who test positive (Treat); and provide the necessary support to help these individuals remain in treatment (Retain, e.g., linking criminal offenders to treatment upon their return to the community). These findings show great promise for preventing the spread of HIV and improving outcomes for those already infected, but studies are now needed to determine the most effective ways to scale up these interventions, especially in the most vulnerable populations.