UNITAID has published its 2014 HIV Preventives Technology and Market Landscape [PDF, 2.1 MB] which shows that although there has been a significant increase in products with promise to curb HIV transmission, scaling up access to them has been slow due to a variety of issues including affordability, availability and demand – all market based.

The report highlights opportunities to change this through efforts to reduce various market obstacles such as the lack of product approval completion.

Although the number of new HIV infections fell by 38% from 2001 to 2013, the number of new infections remains high, with over 2 million people newly infected in 2013 alone.  With AIDS as the sixth leading cause of death globally and the number one cause of death in sub-Saharan Africa, preventing new cases of HIV infection needs to remain a major global health priority.  Preventative tools can substantially contribute if made widely available.

The Landscape summarises products and technologies to prevent HIV infection, including those currently available and those in the development pipeline. It reviews prevention technologies for the major modes of HIV transmission, including sexual transmission, injecting drug use and mother-to-child transmission.

Over the last decade, HIV prevention prospects have been substantially strengthened by the emergence of new biomedical prevention tools, including voluntary medical male circumcision and a series of antiretroviral-based prevention methods. Scale-up of these various tools has been slow, however, underscoring the need to effectively leverage market dynamics to ensure the accessibility and affordability of effective prevention methods.

Over the last year, there have been several developments in HIV prevention technologies. A promising device for adult male circumcision has emerged, a third female condom is closer to WHO prequalification which would make it available for global donor purchase, and new evidence has emerged confirming the effectiveness of pre-exposure antiretroviral prophylaxis.

The report also outlines how biomedical technologies are being tested to examine their role in HIV prevention. The impact of devices to assist with voluntary medical male circumcision on demand, service scale-up and cost is being assessed. Clinical trials of the most recent generations of vaginal microbicides are continuing with results expected in 2015. Additional female condom products are being considered for WHO prequalification which will help enable them to be made more widely available. Whether this will expand use and decrease price remains unclear, however. For some prevention technologies already on the market, such as male condoms, market interventions are unlikely to accelerate further scale-up, as the products are already affordable and are already available. Meanwhile, progress continues, but at a slow pace, in the search for a preventive vaccine.

Among the classes of prevention technologies reviewed in the landscape:

• Male circumcision devices
• Barrier methods (including male and female condoms)
• Microbicides
• Antiretroviral-related prevention methods (including pre- and post-exposure prophylaxis and prevention of mother-to-child transmission)
• Harm reduction technologies
• Longer-term prevention methods (including a preventive vaccine and methods to mitigate the role of herpes simplex virus type-2 in facilitating sexual transmission of HIV). 

In addition to summarizing the current state of prevention technologies, the Landscape details market developments and issues, including shortcomings that create obstacles to access. Potential market interventions are also explored as a guide to future investments.

• Download: 2014 HIV Preventives Technology and Market Landscape [PDF, 2.1 MB]