The Evolution of HIV Prevention Programming: Moving From Intervention to System

Accelerating the fight against HIV globally and achieving the goals of the U.S. National HIV/AIDS Strategy will require an integrated health system that addresses all dimensions of wellness and is not limited to disease diagnosis and treatment or to monolithic prevention strategies. Since the HIV/AIDS epidemic was first recognized in 1981, HIV prevention strategies have evolved from early, information-based efforts to theory-informed and evidence-based approaches. More recently, the growing recognition that social and economic factors play a major role in shaping population health outcomes has driven HIV prevention and care programs in the direction of "people-centered health systems," as called for in the 2016 United Nations General Assembly declaration to end AIDS by 2030. This commentary examines recent innovations in HIV program design and implementation (e.g., using data in novel ways to improve HIV health outcomes, providing incentives to promote integrated HIV prevention and care, and developing mechanisms to proactively address the social determinants affecting health) that embrace a comprehensive vision of health that is much broader than the absence of detectable virus.