National HIV prevention strategies in at least five African countries are not reaching the groups most at risk of infection, according to a report from UNAIDS and the World Bank conducted in conjunction with the national HIV/AIDS authorities of Kenya, Lesotho, Mozambique, Swaziland and Uganda, IRIN/PlusNews reports. The study was conducted between 2007 and 2008 to determine how and where most HIV cases were occurring in each country. It also aimed to examine whether prevention programs and spending aligned with those findings.

According to the report, most prevention initiatives are not based on evidence of the behaviors that spread HIV in the five surveyed countries. For example, most new infections in Lesotho occur because of concurrent sexual partnerships, both before and after marriage. However, the country does not have any prevention strategies aimed at concurrent partnerships, or couples who are married or in long-term relationships.

In addition, the report found that in Mozambique, an estimated 19% of new HIV infections were spread through commercial sex work, 3% from injection drug use (IDU) and 5% among men who have sex with men. According to the report, few programs in the country target sex workers, while none are tailored to IDUs or MSM.

According to the report, spending on HIV prevention often is low in the surveyed countries. Lesotho spends 13% of its national HIV/AIDS budget on prevention, while Uganda spends 34%. Director of the World Bank’s Global HIV/AIDS Unit Debrework Zewdie said that the economic downturn makes it important to maximize the impact of HIV prevention investments. “These syntheses use the growing amounts of data and information available to better understand each country’s epidemic and response and identify how prevention might be more effective,” she said.

The report includes recommendations on how the surveyed countries can better implement evidence-based prevention efforts. It said that Lesotho should revise its prevention messages to address multiple concurrent partnerships and integrate the subject into future initiatives. In addition, Mozambique should focus condom promotion on groups such as sex workers, the report said. According to IRIN/PlusNews, the five-country program aims to enhance capacity to ensure that the countries can conduct similar studies in the future (IRIN/PlusNews, 5/27).