The following was written by Positive Lite editor Bob Leahy.
One hundred and eighty degree turns happen in a variety of ways. Sometimes we seize the steering wheel of our lives and in one fell swoop travel along an opposite path. Other times, we take the turn slowly, one degree at a time, gradually realizing the path we are on leads nowhere and we need to go off in radically new directions. That’s been the case with my realizing that most of my once fervently held objections to treatment as prevention, in 2013, make much less sense than they once did.
Why? In the last decade, our knowledge of disease progression has changed as has how much we know about the impact of ART on our ability to transmit the virus. But treatments have changed too, and so has my own willingness to look at both sides of the argument, to weigh them against each other and to make informed choices which recognize, above all, a shifting environment.
As well, the realist in me tells me that when it comes to HIV prevention, the status quo isn’t working. I respect those who work in the prevention community. But, to be blunt, those who continue to play with the same old tricks – plugging condom use when we know the limits to their efficacy in real life situations, trying to effect behavioural change with the odd stray missile thrown at the social determinants of health – are playing in the wrong sandbox. Let’s not fool ourselves. None of these things will stop the epidemic. We need new tools.
Enter my new friend, treatment as prevention.