Editorial Featured in July 2014
Clinical Infectious Diseases Supplement
The leaders of the Joint United Nations Programme on HIV/AIDS (UNAIDS), International Association of Providers of AIDS Care (IAPAC), and British Columbia Centre for Excellence in HIV/AIDS (BC-CfE) say that now is the time to leverage HIV treatment to maximize its HIV prevention benefits and quicken the pace toward the end of the HIV epidemic.
A multidimensional strategy to achieve these objectives is articulated in an editorial co-authored by Michel SidibÂŽ, UNAIDS Executive Director; JosÂŽ M. Zuniga, PhD, MPH, IAPAC President/CEO; and Julio Montaner, MD, Director of the BC-CfE, which is published in a July 2014, IAPAC-sponsored supplement to the journal Clinical Infectious Diseases entitled, “Controlling the HIV Epidemic with Antiretrovirals.”
The three international leaders in the response to HIV outlined a “re-conceptualized” and “re-designed” global strategy to significantly increase both demand for, and delivery of, HIV treatment. They cite a number of studies, coupled with mathematical modeling, confirming that earlier initiation of antiretroviral therapy, within a robust continuum of care and prevention services, can help to curb overall disease burden.
“Ensuring that all people eligible for antiretroviral therapy have uninterrupted access has to be coupled with strengthened HIV prevention efforts,” said Mr. SidibÂŽ. “Policies that extend the reach and impact of HIV prevention and treatment programmes together must be expanded.”
As the authors note in the editorial, too many people living with HIV who are eligible for HIV treatment, specifically antiretroviral therapy, lack access to this live-saving and -enhancing intervention. Such a coverage gap obstructs the ability to achieve individual-, community-, and population-level reductions in AIDS-related morbidity and mortality.
“Although antiretroviral therapy has re-shaped the AIDS response, the HIV treatment revolution has yet to reach many around the world,” said Dr. Zuniga. “We must do what must be done now: Get people tested. Link people who test HIV negative to prevention services. Link people who test HIV positive but who are not clinically eligible for antiretroviral therapy by current criteria to comprehensive, holistic care. And, treat people who need ART so that they can stay alive, healthy, and productive members of society.”
The editorial’s authors urge action to streamline and achieve efficiencies in service delivery; generate treatment demand (e.g., increase testing and linkage to care); make smart investments and demand return on those investments; set ambitious HIV treatment targets; and measure progress against goals such as knowledge of HIV status, linkage to care, and long-term retention in care.
“With so much at stake, and with the tools at our disposal to envision the end of AIDS, there is no room for complacency,” said Dr. Montaner. “We must leverage the full potential of HIV treatment to prevent not just AIDS-related morbidity and mortality, but also HIV transmission, thus avoiding the inevitable cost of inaction. We must hold nothing back to transform the end of AIDS into reality.”