[Viva] Fwd: CATIE News - Guiding principles on the use of HIV treatment as prevention: an international community consensus statement

Tue Mar 18 10:32:56 PDT 2014

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From: CATIE <mailer at catie.ca>
Date: Tue, Mar 18, 2014 at 10:02 AM
Subject: CATIE News - Guiding principles on the use of HIV treatment as
prevention: an international community consensus statement
To: dbecker106 at gmail.com

     CATIE News - Bite-sized HIV and hepatitis C news bulletins
       CATIE News - Guiding principles on the use of HIV treatment as
prevention: an international community consensus statement

One of the most significant developments in HIV research in the past few
years has been the discovery that antiretroviral therapy (ART) can
dramatically reduce the risk of HIV transmission. Indeed, research
continues to emerge that supports the use of ART as an HIV prevention tool
for HIV-positive individuals and as a public health strategy to reduce new
HIV infections within some populations. While promising, the use of ART for
prevention has raised some concerns among people living with HIV, their
communities and their caregivers. A lack of guiding principles has also
resulted in some uncertainty as to how this information should be
integrated into frontline prevention work.

To address these concerns, the European AIDS Treatment Group (EATG), in
collaboration with the England-based HIV organization NAM, recently
released a community consensus statement on the use of HIV treatment as
prevention. This statement contains a series of guiding principles to help
move treatment as prevention forward in a way that protects the rights,
dignity, self-determination and overall health and well-being of people
living with HIV and their partners. These principles were developed through
a community-driven process, within a Greater Involvement of People Living
with HIV and AIDS (GIPA) framework.

These are some highlights of the statement's principles:

*People living with HIV, as well as those who are HIV-negative, should be
informed of the prevention benefits of treatment. *ART represents an
important option for preventing HIV transmission and may have other
important benefits as well. For example, it may reduce stigma towards
people living with HIV and it may also reduce the guilt, blame and anxiety
associated with the possibility of transmitting HIV to a partner. However,
many people with HIV and many people vulnerable to HIV are unaware of these
benefits of ART. Therefore, the statement recommends that healthcare and
other service providers talk to their patients and clients about the
prevention benefits of ART. The statement warns that "HIV prevention should
not be viewed as an aim of ART that is separate from the overall health and
wellbeing of the person taking it." Training and information resources are
needed for service providers.

*Nobody should be coerced or pressured into getting tested for HIV or
starting ART for prevention purposes. *Getting tested for HIV and starting
ART are important decisions that are not without challenges and risks. For
example, treatment generally requires life-long adherence to daily
pill-taking and can have short and long term side-effects. Therefore, the
statement recommends that service providers develop safeguards to prevent
coercion and ensure that the decision to start treatment is the free choice
of the person living with HIV. According to the statement, "the provision
of ART for prevention purposes should never violate individuals' rights to
health, self-determination, consent or confidentiality." Pressure or
coercion may come from various sources, such as sex partners, public health
workers or other service providers.

*Assessing an HIV-positive person's readiness to start ART is important and
should begin early (when a person's CD4 counts are high). *Treatment
readiness is important to ensure that a client/patient makes an informed
decision and is prepared to adhere to daily pill-taking once ART is
started. Tools are needed to help assess an individual's readiness to start
treatment and some have already been developed.

*ART should be considered one part of a comprehensive approach to improving
HIV prevention and the health of people living with HIV. *Although it is an
important component of the response to HIV, treatment as prevention will
not by itself end the epidemic. This strategy should not draw attention
away from other effective HIV prevention strategies, such as risk-reduction
counselling, the use of sterile equipment for injecting drugs, condom use
and social support programs. Furthermore, increasing the number of people
on successful ART is dependent on improving other aspects of the response
to HIV, such as access to testing, care and support. Approaches to
improving the health of those living with HIV should be holistic and go
beyond ART: They must "be part of a general programme whose aim is to
improve the physical and emotional health and social position of people
with HIV and their partners."
 Conclusion

The community consensus statement provides important guidance on how HIV
treatment as prevention should be integrated into frontline work. Hopefully
the statement will encourage further discussions on this topic, as well as
the development and implementation of new and enhanced services that aim to
safeguard "the health and wellbeing of people living with HIV, whether they
choose to take ART or not." Individuals and organizations can sign
on<http://www.hivt4p.org/>and endorse this statement online.

*--James Wilton*

*Resources*

Community consensus statement on the use of antiretroviral therapy in
preventing HIV transmission<http://www.hivt4p.org/wp-content/uploads/2014/02/Community-consensus-statement-with-appendices-and-references.pdf>-
NAM and EATG

Treatment and viral load: what do we know about their effect on HIV
transmission?<http://www.catie.ca/en/pif/fall-2013/treatment-viral-load-and-hiv-transmission>-
*Prevention
in Focus*, Fall 2013.

Treatment as prevention: do the individual prevention benefits translate to
the population level?<http://www.catie.ca/en/pif/fall-2013/treatment-prevention-do-individual-prevention-benefits-translate-population-level>-
*Prevention
in Focus*, Fall 2013.

HIV viral load, HIV treatment and sexual HIV
transmission<http://www.catie.ca/en/fact-sheets/transmission/hiv-viral-load-hiv-treatment-and-sexual-hiv-transmission>-
CATIE fact sheet.

Starting and staying on
treatment<http://www.catie.ca/en/treatment/hiv#starting>- a collection
of CATIE resources.

The Vancouver STOP Project
<http://www.catie.ca/en/pc/stop-hivaids-project>- *Programming
Connection*.

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