Global HIV Prevention Working Group Releases Report on Integrating Prevention Into Treatment Strategies
With increased access to antiretroviral treatment in developing countries throughout the world, prevention could be "neglected," resulting in "even more" new HIV cases, according to a report released on Thursday by the Global HIV Prevention Working Group, the New York Times reports. According to the report, widespread access to HIV/AIDS treatment could have the "unintended consequence" of giving people a "false sense of security" that the epidemic is over, according to the Times (Altman, New York Times, 6/11). The report, titled "HIV Prevention in the Era of Expanded Treatment Access," is the first major report to examine global HIV prevention during a period of increasing treatment access, according to a working group release. The working group, which was convened in 2002 by the Bill & Melinda Gates Foundation and the Kaiser Family Foundation, is comprised of nearly 50 experts in public health; clinical care; biomedical, behavioral and social research; and people affected by HIV/AIDS. The report says there is an "unprecedented opportunity to forge a comprehensive response to the global AIDS epidemic by integrating HIV prevention interventions into expanding treatment programs," according to the release (Global HIV Prevention Working Group release, 6/10).
According to the report, "[e]ffective prevention involves a series of strategies that achieve maximum impact when pursued in combination" (Global HIV Prevention Working Group, "HIV Prevention in the Era of Expanded Treatment Access," June 2004). Therefore, the report calls for countries to strengthen prevention programs and combine them with treatment programs, the Times reports. The working group calls for the widespread promotion of condom use, voluntary HIV counseling and testing and the administration of drugs to prevent mother-to-child HIV transmission, according to the Times. The report also calls for the implementation of additional programs aimed at changing behavior among high-risk groups; programs that discourage sex at an early age; promote monogamy and sexual abstinence; and support harm reduction among injection drug users. Currently, fewer than one in five people who are at high risk of contracting HIV have access to prevention programs, according to the Times (New York Times, 6/11).
'Opt-Out' HIV Testing
The report also recommends a policy shift from testing for HIV "upon request" to "opt-out" testing, in which health care providers test for HIV on a routine basis unless people specifically refuse the test, the Wall Street Journal reports. As much as 90% of HIV-positive people in developing countries are not aware of their HIV status, the Journal reports. However, some advocates expressed concern about changing testing policies, according to the Journal. Joanne Csete, director of the Human Rights Watch HIV/AIDS Program, said that some women in Africa and Asia who test HIV-positive could face violence or abandonment by their partners, the Journal reports. Dr. Helene Gayle, director of HIV, tuberculosis and reproductive health for the Gates Foundation and co-chair of the working group, called for a three-fold increase in spending for prevention programs to about $6 billion by 2005, the Journal reports. If prevention funding is not increased, treatment programs "will never keep pace with the spread of HIV," Gayle added, according to the Wall Street Journal (Chase, Wall Street Journal, 6/11). She said that identifying more HIV-positive people in the early stages of the disease to educate them about prevention could reduce the number of new HIV cases "during the seven- to 10-year period when infected people can easily transmit the virus even though they feel well," according to the Times (New York Times, 6/11).
Gayle said, "Because HIV is no longer an automatic death sentence, we must anticipate behavioral shifts and explain the benefits and limits of current therapies." Dr. Paulo Teixeira, former director of the World Health Organization HIV/AIDS program, said, "There was a long period where prevention and treatment were considered as opposite strategies" and "it was necessary to choose between them." However, now the two approaches "must be done in concert," he added, according to the Times (New York Times, 6/11). Kaiser Family Foundation President and CEO Drew Altman said, "The challenge now is to make scaling up our number-one priority in the fight against HIV and to scale up prevention and treatment in tandem" (Global HIV Prevention Working Group release, 6/10). UNAIDS Executive Director Peter Piot said that "if you do only treatment, you'll have more infections because the perception is the problem is fixed." Gayle added, "Treatment (alone) ... isn't a solution to the epidemic" (Wall Street Journal, 6/11). She said that combining treatment and prevention strategies is "the best chance the world has had to build a comprehensive response to the global epidemic," adding, "More widespread access to treatment is likely to bring millions of people into health care settings, providing new opportunities for health care workers to deliver and reinforce HIV prevention messages" (Ross, AP/South Florida Sun-Sentinel, 6/11).
The report, as well as past reports from the Global HIV Prevention Working Group, are available online.