Multiple biomedical prevention strategies (condoms, PrEP, circumcision and ART adherence) have been found to be superior in modeling studies compared to single strategies among sero-discordant couples in reducing the risk of HIV transmission over a number of years with ART adherence being the most effective single strategy, and PrEP and condoms the least effective when used alone, partially due to the difficulties of adherence.
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For example, sexual risk among stimulant users is associated with several factors including sex for drug or money exchanges among men and women, the use of drugs to help cope with commercial sex work, sexual violence against crack users who engage in sex exchanges, poverty, and the stigma of drug use and sex work. Combination prevention approaches are thought to be better at preventing HIV from sexual- and drug-risk behaviors because of the complexity of the causes of risk behaviors, the difficulty of maintaining strict adherence to prevention behaviors, and in covering or reaching all key populations at risk for HIV with prevention materials. Researchers increasingly call for a combination of biomedical, behavioral, social and structural strategies, called combination prevention interventions, as the best way to reduce HIV incidence.