AFRICA: Expanded access to treatment provides prevention opportunities
[This report does not necessarily reflect the views of the United Nations]
JOHANNESBURG, 23 July (PLUSNEWS) - Long-term success against AIDS requires the simultaneous expansion of both antiretroviral therapy (ART) and prevention, says a recently released report by The Global HIV Prevention Work Group.
In an era of increased access to HIV treatment there was an urgent need to integrate prevention into health care settings and adapt prevention strategies.
"Unless the incidence of HIV is sharply reduced, HIV treatment will not be able to keep pace with all those who will need therapy. For example, while the WHO/UNAIDS '3 by 5' initiative establishes the goal of having 3 million people on ART by 2005, 5 million new infections occur every year," said the report, 'HIV Prevention in the Era of Expanded Treatment Access'.
But all was not lost, because more widespread access to HIV treatment means that millions of people were entering health care settings, providing new opportunities for health care workers to deliver and reinforce HIV prevention messages and interventions.
"Rapid scale-up of HIV treatment and prevention could improve the lives of millions, avert countless new infections and, ultimately, contain the global AIDS epidemic," the report noted.
Pilot programmes across developing countries were demonstrating that an approach integrating HIV prevention with access to HIV treatment was feasible and could substantially increase both condom use and HIV testing rates.
The group formalised recommendations on new approaches to HIV prevention, including programmes taking into account the different needs of HIV-positive and HIV-negative people.
For example, although most people diagnosed with HIV took steps to avoid exposing others to the virus, some had difficulty maintaining safer behaviour, making "prevention for positives" critical to reducing the number of new infections.
As HIV treatment expanded, prevention strategies for HIV-negative and untested people should emphasise the continuing importance of risk reduction, while stressing the limitations of ART. "Behavioural and sentinel surveillance must be significantly expanded to monitor the effect of ART access on risk behaviours and trends in HIV prevalence," the researchers suggested.
HIV prevention and treatment could be better integrated by significantly expanding and aggressively promoting HIV testing programmes - a critical entry point for both prevention and ART services.
Prevention and treatment services should be tailored to meet the specific needs of women, with special attention paid to ensure that young people entered the health care system much earlier.
"Prevention outreach programmes should promote HIV testing, educate communities about HIV treatments and facilitate linkages to care," the report commented.
Organisations of people living with HIV should be involved in the planning, development, delivery and evaluation of HIV prevention services directed at them.
To realise a simultaneous scaling-up of prevention and treatment, funding would have to increase to US $10.5 billion in 2005 and $15 billion in 2007, as recommended by UNAIDS. Research into prevention technologies, such as microbicides and female condoms, also needed to increase.
The Global HIV Prevention Working Group consists of nearly 50 leading public health experts, clinicians, biomedical and behavioural researchers, and people infected by HIV/AIDS. It is convened by the Bill and Melinda Gates Foundation and the Henry J. Kaiser Family Foundation.
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