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Abstract
The control of the HIV epidemic is a momentous challenge. Despite successes in some situations, HIV transmission has not been adequately reduced by the HIV prevention methods currently available. This is demonstrated by the continuing spread of the HIV epidemic, mainly through sexual transmission. The approaches to HIV prevention have broadly been defined as structural, behavioural and biomedical. The objectives of this thesis were to examine the personal and public health impact of selected biomedical HIV prevention technologies on HIV acquisition and HIV risk behaviour and to explore a number of the specific scientific and methodological challenges encountered in the field of development of HIV prevention technologies. The following research aimed to add to the available Australian data on biomedical HIV prevention, and to determine the potential for future trials of HIV biomedical prevention in Australia.
A number of key findings from this thesis contribute to knowledge in the area of biomedical HIV prevention research. Firstly, the design of published safety studies of candidate vaginal microbicides was not sufficient to detect potential toxic effects of these products. A second important contribution was the demonstration that there was no evidence of behavioural disinhibition after non-occupational post-exposure prophylaxis for HIV (NPEP) use. Thirdly, NPEP had an important protective effect against HIV acquisition at an individual level but not at a population level. Fourth, groups with high HIV incidence could be readily identified in low HIV incidence settings. Finally, men with higher levels of HIV risk were more willing to participate in clinical trials of biomedical HIV prevention technologies.
The research in this thesis underlines the complex nature of biomedical HIV prevention research and HIV prevention implementation, from the design of clinical trials of candidate biomedical HIV prevention products, to identifying suitable study populations who are willing to take part in such trials and finally to implementing the use of such technologies. HIV prevention remains a global public health priority and it is imperative that efforts to identify safe and effective biomedical HIV prevention technologies continue.