A groundbreaking year in HIV treatment and prevention
It’s historic. It’s inspiring. Evidence that has been building over the past few years about the treatment and prevention of HIV is so significant, some people are calling it revolutionary. Showcased at this year’s International AIDS Society (IAS) conference in Vancouver, our new information forever changes the prospects of health for those living with HIV, their partners and the broader community.
What we now know: It is advantageous for people with HIV to begin treatment as soon as possible after diagnosis, both for their own health and for the health of the community. New research tells us that early, lifelong use of antiretroviral treatment (ART) by people living with HIV leads to better health and a near-normal life expectancy. Additionally, when the consistent and correct use of ART results in an undetectable viral load, it can reduce the risk of transmitting HIV to another person by 90 per cent or more.
Faced with such compelling evidence, the World Health Organization (WHO) recently announced new guidelines recommending that antiretroviral treatment be started in everyone living with HIV regardless of the stage of their infection. Authorities in the U.S. and U.K. have released similar guidelines. The WHO also released new evidence-based guidelines on HIV testing services, noting that the benefits of treatment can only be realized if people with HIV are diagnosed.
The WHO also endorses the use of daily, oral pre-exposure prophylaxis (PrEP) by an HIV-negative person to prevent infection. Studies demonstrate that the anti-HIV drug Truvada is highly effective at preventing infection when taken consistently and correctly. Hopefully availability of the drug will be much improved. Following an April campaign led by the Vancouver-based Health Initiative for Men, Truvada manufacturer Gilead asked Health Canada to approve the drug for use as PrEP in Canada, as it is in the United States. (While we wait for such approval, it is still possible for healthcare providers to prescribe Truvada as PrEP ‘off label.’)
This new science has far-reaching implications for how frontline service providers do their job. Frontline service providers can counsel and support clients at every stage of their treatment and care journey. That involves sharing with people the important clinical and prevention benefits of ART. It may also involve encouraging the consideration of combination HIV prevention methods, including pre-exposure prophylaxis (PrEP), never forgetting that condoms remain the cornerstone of efforts to prevent the spread of HIV and other sexually transmitted infections (STIs).
The links between prevention and treatment require a new way of thinking about delivering HIV programs and services. Those working in the field of HIV prevention, for example, can no longer think of treatment and PrEP as outside their scope of practice, as they are now considered primary prevention tools. And those working in clinical settings must recognize the crucial role of community-based organizations in engaging, supporting and retaining clients in care.
While new science is changing the way frontline service does its job, there is also a huge role for countries to play. Canada’s national strategy for responding to the HIV epidemic was written long before these scientific revelations. We must now develop a new strategy, as have many other countries around the world. The Vancouver Consensus, launched at the International AIDS Society conference, posed a compelling question equally applicable to our political leaders and our frontline service providers: Science has delivered solutions. The question for the world is: When will we put it into practice?