At the 3rd International HIV Treatment as Prevention Workshop in Vancouver, Canada, in April 2013 I was asked to put forward the case that “Pre-Exposure Prophylaxis (PreP) is not an essential component of Treatment as Prevention (TasP)”. So my job was to convince the public that while PreP may be a useful, and even an important, addition to TasP it is by no means an essential component of TasP. Here I reproduce my argument and invite readers of the SACEMA Quarterly to express their own views on this important issue.
Scientists at SACEMA have been in the forefront of those arguing that the time to end AIDS is now and the way to do this is through the strategic use of potent anti-retroviral therapy (ART). The road ahead will be long and hard and much still needs to be done. If we are to increase the number of people in the world who are on ART from the present 5 million to 15 million by, say, 2015 and to 30 million by 2020, many operational challenges will have to be understood and met. Here we outline the most important issues that need to be explored if treatment-as-prevention is to become a reality and if we are to end AIDS.
Behaviour change interventions have not brought about a sufficient reduction in HIV transmission. The question is whether anti-retroviral therapy (ART), used to effectively treat HIV patients, could also be used to stop transmission. This article discusses whether treatment-as-prevention is feasible, by determining the extent to which ART reduces the infectiousness of HIV-positive people. Furthermore, it looks at whether this is a realistic approach, by considering the levels of acceptance and compliance that might be achieved, the cost of the drugs, the rate of development of resistance, drug delivery and patient management.
The Lancet recently reported that universal HIV testing and immediate antiretroviral therapy (ART) for everyone diagnosed with HIV in countries such as South Africa could reduce new infections by 95% within ten years. This article describes the benefits and objections (costs, human resources, side effects, drug resistance) to the idea of starting all HIV positives on ART in South Africa, including the way forward.