>The sixth debate of the Emerging Issues in Today’s HIV Response Debate Series titled, “Treatment as Prevention” featured expert panelists arguing for and against the proposition:
“Countries should spend a majority of what is likely to be a flat or even declining HIV prevention budget on ‘treatment as prevention’.”
Recent studies have shown that persons living with HIV who are on antiretroviral treatment, are much less infectious and therefore much less likely to transmit HIV to others. The HPTN-052 randomised study found a 96% reduction in HIV transmission from an HIV-infected person to his/her sexual partner, for the 76% of cases where intra-couple transmission took place. Results suggesting similar levels of acquisition risk reduction were reported in the 2010 Partners in Prevention study. What do these latest results mean for HIV prevention programming? Should “treatment as prevention” become HIV prevention policy in countries? For all persons or only for adults in long-term sexual partnerships? Does the type of epidemic (i.e. concentrated, mixed, generalized) matter? How feasible are these interventions? Is it ethical not to implement them, given that their efficacy between long-term sexual partners is known? Should prevention resources be diverted away from other interventions, such as behavior change efforts, to fund increased ART? Who will pay for costs of the increased volumes of drugs? Do we know enough about the side-effects or about drug resistance? These questions and others related to treatment as prevention were discussed.