June 11, 2011
For the first time in the 30 years of the HIV epidemic, there is now conclusive evidence showing that earlier initiation of highly active combination antiretroviral therapy (ART) at 350-550 CD4 cells/mm3 is a highly powerful tool for preventing transmission to sex partners and has clinical benefit for HIV-positive people.
Now is the time to change the approach to the epidemic. Funding needs to be directed to evidence-based strategies with ART as a cornerstone of the set of proven strategies we have to prevent and treat HIV. These also include male and female condoms, male circumcision, prevention of vertical transmission, behavior change programmes that target social norms as well as individual risk, and activities addressing key populations including sex workers, gay men and other men who have sex with men, transgender women, and harm reduction programs for injecting drug users. Funds that are not aligned with these core activities need to be justified and, where applicable, reprogrammed.
These biomedical, structural and behavioral interventions need to be delivered in the context of a community-centered mobilization for health and rights. Emerging and experimental strategies such as AIDS vaccines, microbicides, pre-exposure prophylaxis and eradication strategies may provide additional tools for reducing incidence in the future.
The data from HPTN 052 make it more urgent than ever that all nations accelerate efforts to diagnose, counsel, support and offer early treatment to all people living with HIV, including the many millions who do not yet know their status. While we acknowledge that countries are still trying to reach universal access to treatment under current WHO treatment guidelines criterion (CD4 cell count less than 350), and that more data on individual and population-level impacts of initiating treatment at a CD4 cell count less than 500 are needed, particularly in resource-poor settings, the existing data suggest that every person living with an HIV CD4 cell count less than 500 who is not offered ART may potentially represent a missed opportunity both to avert AIDS-defining illness, especially TB, and to prevent new infections. The obligation to protect human rights and public health require that we act with urgency to translate the HPTN 052 data into practice.
Non-integrated, artificially separated approaches to funding and delivering treatment and prevention services must be replaced with integrated approaches linking newly diagnosed HIV-positive people to comprehensive support and care programs, including ART. This will optimize the benefits to individual health and to public health. These programs must be used as a platform for linking HIV-negative individuals to the full range of evidence-based prevention methods.
The global response to AIDS is at a turning point. On the eve of the 2011 United Nations High-Level Meeting on AIDS, we call all governments, donors, international agencies, researchers, implementers and civil society to act on this evidence and end the AIDS epidemic now. We can, and we must.
African Services Committee, United States of America
AIDS Foundation of Chicago, United States of America
AIDS Treatment Activists Coalition, United States of America
AIDS United, United States of America
amfAR, The Foundation for AIDS Research, United States of America
AVAC: Global Advocacy for HIV Prevention, United States of America
The ATHENA Network, Global
Black AIDS Institute, United States of America
The Canadian HIV/AIDS Legal Network, Canada
Fenway Health/The Fenway Institute, United States of America
Grupo for Life Incentive (GIV), São Paulo, Brazil
Global Network of People living with HIV (GNP+), Global
Harlem United, United States of America
Health GAP, United States of America
HIV Prevention Justice Alliance (HIV PJA), United States of America
International Community of Women Living with HIV (ICW), Global
International Rectal Microbicide Advocates, Global
International Treatment Preparedness Coalition, Global
New HIV Vaccine and Microbicide Advocacy Society, Nigeria
Open Society Public Health Program, United States of America
Partners In Health, Global
Project Inform, United States of America
Treatment Action Campaign, South Africa
Treatment Action Group, United States of America
Wits Institute for Reproductive Health and HIV (WRHI), South Africa