HIV treatment as HIV prevention debate

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The notion of antiretroviral treatment as a form of HIV prevention is in the news again, following a presentation by Brian Williams at the 

American Association for the Advancement of Science meeting in San Diego (

http://www.guardian.co.uk/world/2010/feb/21/blanket-testing-hiv-aids). Commentators including Elisabeth Pisani have questioned the wisdom of putting all the prevention “eggs” in the ART basket, asking whether expanded treatment programmes will really reach people who are in their most infectious period, and suggesting that expanded treatment can desensitise people to the need for preventive behaviours (http://www.guardian.co.uk/commentisfree/2010/feb/22/the-drugs-wont-work).

The idea of treatment as prevention has been around for a long time, but I have always felt a bit dubious about activism that implies that the prevention benefits justify the expansion of ART.  I’ve always assumed that the effect of ART on mortality and quality of life should be justification enough.  I can see why some might think this is a naive assumption, given the looming threat of funding being taken away from treatment programmes – of a reversal of the hard-fought battle to win access to HIV treatment for millions of people around the world. 

Nonetheless, there are other questions raised by this debate.  The global health movement has learned a huge amount from the fight against HIV and AIDS – in terms of activism for access to treatment, certainly.  But also in terms of the role that communities can play in improving health; in terms of the links between human rights and health; and in terms of the need for exceptional responses to some health challenges, especially where stigmatised and marginalised groups are the most affected.  If rapid access to HIV treatment proves not only to prolong the lives of people infected, but also to cut further HIV transmission, then that’s great news.  But let’s not forget that it was human actions, not technological fixes that got the response to HIV and AIDS to where it is today; and that the broader global health movement needs above all to learn from this.

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