A new paper in the New England Journal of Medicine highlights the global disparities in the knowledge and utilization of treatment as prevention (TasP) in stopping the spread of new HIV infections. Co-written by Dr. Kenneth Mayer, Medical Research Director at Fenway Health and Co-Director of The Fenway Institute, “A Failure to Disseminate Transformative Science — HIV Treatment as Prevention, 10 Years On” calls for a significant scaling up of information sharing about TasP among clinicians and advocates worldwide.
TasP has long been a proven method of HIV prevention and a key strategy of the Getting to Zero initiative for ending new HIV infections and HIV-related deaths. The results of the HIV Prevention Trials Network (HPTN) 052 trial, which was published over a decade ago in August of 2011, demonstrated that viral load suppression via antiretroviral therapy in HIV-positive patients is highly effective in preventing community HIV transmissions. The popular slogan “undetectable equals untransmittable,” or “U=U,” comes from this research. The Fenway Institute at Fenway Health served as a study sites for HPTN 052.
“HPTN 052 catalyzed a sweeping revision of HIV policy goals,” the paper’s authors explain. “Starting treatment for people with HIV became a central pillar of HIV-prevention efforts, which had previously focused on promoting condom use, abstinence, monogamy, and circumcision. Treatment policy changed, too… in 2015 the World Health Organization (WHO) recommended that all people with HIV start ART at the time of diagnosis.”
While nearly every country has adopted ART as a matter of HIV treatment policy, the message that ART is an effective way of stopping HIV transmission has not been as widely disseminated. research has shown that awareness of TasP was greatest among men who have sex with men living in the Global North, although there are misperceptions about transmission risks even among this demographic. In sub-Saharan Africa, data suggests that many provides, patients, and members of the public aren’t aware of the existence and efficacy of TasP. Students at an urban South African university believed there was a 73% annual risk of transmission in a mixed-status couple in which the partner with HIV was virally suppressed. And in the U.S., just 2% of women were able to name TasP as an effective HIV-prevention method.
As the paper’s authors emphasize, the wealth of data around TASP as prevention makes it clear that sharing information on TasP and the fact that U=U is not only an ethical imperative, but a clinical and public health best practice as well.
“For more than a decade, we have known that HIV-positive people whose virus is fully suppressed on antiretroviral therapy don’t transmit HIV, but many providers and at risk people have remained unaware,” said Dr. Mayer. “Our paper is a call for wider awareness so that more people can benefit from the personal and public health benefits of antiretroviral therapy.”
You can read the full paper here.