HIV Prevention Strategies in Vulnerable Populations

The HIV epidemic remains a leading global health challenge, particularly among marginalised groups facing socioeconomic, gender and geographic barriers. Prevention strategies encompass biomedical, behavioural and structural interventions. Biomedical approaches such as universal test-and-treat, pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision (VMMC) have been scaled up in high-burden settings. Behavioural measures include peer support, community outreach and tailored education to promote safer sexual practices and adherence to prevention tools. Structural strategies address underlying drivers of vulnerability—poverty, gender inequality, stigma and limited access—through economic empowerment, policy reform and integration of HIV services within broader health systems. Embedding HIV prevention within sexual and reproductive health, non-communicable disease care or community-based platforms leverages existing infrastructures to reach adolescent girls and young women, sex workers, men who have sex with men and rural populations. Combination prevention, informed by real-time epidemiological data and community engagement, has emerged as the paradigm for closing persistent gaps in diagnosis, linkage to care and retention. Coordination across sectors and culturally sensitive delivery remain essential to reduce new infections among the most vulnerable.

Research from Nature Portfolio

Longitudinal surveillance in a hyperendemic South African cohort demonstrated a 43% decline in HIV incidence between 2012 and 2017 following the rapid expansion of VMMC and antiretroviral therapy (ART). Over 92 000 person-years of observation among more than 22 000 initially uninfected adults revealed that men experienced a 59% reduction in seroconversion rates, while women saw a 37% decline. These findings provide robust evidence that population-level scale-up of biomedical prevention services can achieve substantial decreases in new infections in rural, high-burden settings.

HIV Prevention Strategies in Vulnerable Populations publication trend

The graph below shows the total number of articles in hiv prevention strategies in vulnerable populations across all publications each year (not limited to Nature Index journals).

Technical terms

Pre-exposure prophylaxis (PrEP): use of antiretroviral medication by HIV-negative individuals to prevent infection.

Antiretroviral therapy (ART): combination drug regimen used to suppress viral replication in people living with HIV.

Voluntary medical male circumcision (VMMC): surgical procedure shown to decrease the risk of female-to-male HIV acquisition.

Serostatus neutral interventions: prevention strategies applicable to individuals irrespective of their HIV status.

Agent-based modelling: computational method simulating interactions among individuals to predict disease transmission and intervention outcomes.

References

1. Declines in HIV incidence among men and women in a South African population-based cohort. Nature Communications (2019).
2. Effectiveness of integrating HIV prevention within sexual reproductive health services with or without peer support among adolescents and young adults in rural KwaZulu-Natal, South Africa (Isisekelo Sempilo): 2 × 2 factorial, open-label, randomised controlled trial. The Lancet HIV (2024).
3. Estimated contributions and future mitigation strategies for HIV risk around funeral practices in western Kenya: a mathematical modeling study. BMC Medicine (2025).