Treatment as Prevention: Challenges and Opportunities

This Global Health Council Fact Sheet summarises findings on treatment of HIV and AIDS as a prevention strategy [Footnotes removed by editor throughout]: “'Treatment as prevention' refers to the prevention of HIV transmission by treating people living with HIV/AIDS (PLWHA) with anti-retroviral therapy (ART). PLWHA on ART have plasma viral loads up to six times lower than those not on ART. This means they have fewer copies of the HIV circulating in their bodies and are less likely to transmit the virus."

It presents evidence of efficacy of a “test-and-treat” policy including frequent HIV testing combined with immediate treatment of all positive cases. The resources needed include the following:

• A scale-up of HIV testing. "More frequent testing will be necessary to identify PLWHA in the early stages of the disease, particularly during the period of high infectiousness.
• Implementing a test-and-treat policy. This would increase the number of people in need of treatment [specifically ART]. While many health systems are still struggling to meet current demand. In 2009, only 36 percent of patients that were eligible for ART received treatment in low- and middle-income countries."

Ethics and human rights concerns include: "There is concern that the community benefit of treatment as prevention could lead some governments to institute mandatory testing and treatment policies, a potential violation of human rights and individual autonomy."

Drug resistance is a concern requiring close monitoring, as stated here. Behaviour change is an objective: "Earlier treatment and education about treatment as prevention could possibly lead to decreased sexual inhibition, including reduced condom use, if HIV risk perception was lowered."

Publisher: Global Health Council