Searching for effective HIV-prevention and care in sub-Saharan Africa: focusing on local contexts

After 20 years of experience with HIV prevention, the number of people infected with HIV continues to rise, and there are still few examples of declining epidemics. Why have we not done better? This proposal is a response to the urgent need to document wh at works in community HIV prevention and care programs. Effective HIV prevention will have to be guided by appropriate knowledge on the local epidemiological, cultural and socio-economic contexts, and many countries have restrained access to this type of knowledge. Moreover, the complexities involved in HIV prevention call for much stronger multidisciplinary efforts in research and development. The project is a continuation and extension of an ongoing RCN/Global health funded project (164049/S30, 01.10.2 004-31.10.2006). The ongoing project is progressing well and will benefit from the proposed extensions. The common focus is on the generation of appropriate knowledge on local contexts. The sharp differentials in the dynamics and trends of HIV transmissio n within the region make it important to cover different research sites (Zambia, South Africa, Malawi, Eritrea and Tanzania). Besides having a general population approach, the project includes components targeting young people and the family, prevention o f mother-to-child transmission, and interventions related to the community approaches to support orphans. Finally, with a new partner, the focus is extended to issues that relate to institutional and financial structures at national and local levels. Beh ind the application is an interdisciplinary group of researchers with longstanding experience from HIV-related research (several NUFU- and EU-funded projects). Through these projects, an extensive network of researchers and institutions in sub-Saharan Afr ica and Europe has been established. The projects have a strong capacity building focus, and a substantial number of students from the South partners alralready enrolled in research training.