Expert Think Tank Meeting on HIV Prevention in High-Prevalence Countries in Southern Africa Report

The Southern African Development Community (SADC) is at the epicenter of the global HIV epidemic. According to the latest estimates by UNAIDS the average adult HIV prevalence rate in this subregion is about 11 percent compared to one percent globally. It is estimated that approximately 40 percent of all people living with HIV globally are living in the SADC region and approximately 37 percent of all new infections in 2005 occurred in this region.

Concerned by the continuing increase in the epidemic and in support of the Year for Accelerating Access to HIV Prevention, the Secretariat of the Southern African Development Community (SADC), with the support of the Regional HIV Prevention Group comprising UNAIDS, UNFPA,WHO, UNICEF, Sida and USAID, convened a three-day Expert Think Tank Meeting on HIV Prevention in High- Prevalence Countries in Southern Africa.

The meeting was attended by 38 participants comprising representatives from National AIDS Councils, HIV prevention focal points, leading prevention experts, the SADC Secretariat, the United Nations, Sida, USAID, research institutions and non-governmental organisations.

The meeting participants analysed the evidence on the drivers of the epidemic in the sub-region focusing specifically on sexual transmission of HIV and made proposals to accelerate prevention efforts over the coming year to two years. Key drivers of the epidemic in southern Africa identified by the participants included multiple concurrent partnerships by men and women with low consistent condom use, and in the context of low levels of male circumcision. Male attitudes and behaviours, intergenerational sex, gender and sexual violence, stigma, lack of openness, untreated viral STIs and lack of consistent condom usage in long-term multiple and concurrent partnerships were identified as significant contributing drivers of the epidemic. Underlying these drivers are the social and structural factors such as high population mobility, inequalities of wealth, cultural factors and gender inequality that render young women especially vulnerable to HIV infection.

The meeting participants concluded that amongst other recommendations, priority should be given to interventions that aim to:

• Reduce the number of multiple and concurrent partnerships;
• Prepare for the possible roll out of male circumcision;
• Address male involvement and responsibility for sexual and reproductive health, HIV prevention and support;
• Increase consistent and correct condom use; and
• Continue programming around delayed sexual debut in the context of condom programming and reduced partnerships.

The meeting participants also recommended that the National AIDS Councils undertake national reviews of the evidence regarding HIV prevention, the drivers of the epidemic, policies, programmes and work plans, taking into account the evidence emerging from the SADC Expert Think Tank Meeting.

The participants recommended that SADC and the International Cooperating Partners continue to undertake advocacy efforts on changing behaviour and social norms targeting leaders within the region; support countries in undertaking their national consultative process on HIV prevention; facilitate a review of the evidence and research regarding behaviour change, social norms, male circumcision, counseling and testing; and strengthen monitoring and evaluation.

Copies of the report and an accompanying CD-ROM with all the presentations and peer reviewed articles from international journals that formed the basis of the discussion, are available from the contacts below.