The year is rushing to a close. World Aids Day is around the corner, and from our vantage point at SACEMA, 2011 is likely to be remembered as the year in which the concept of Treatment as Prevention (TasP) stopped being controversial. Few now seriously express doubt that effective ARV treatment cuts transmission, and debate has moved on to grapple with the questions of the extent, and over what time scale, this can translate into ‘game changing’ or ‘paradigm shifting’ scenarios.
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.