Call for human rights-based guidance on PrEP and ART as prevention
Amsterdam, 18 July 2011 - Preliminary results from two large studies have now shown that a daily antiretroviral tablet taken by people who do not have HIV reduces their risk of contracting HIV by up to 73%.
The Partners PrEP trial involved 4758 HIV-discordant couples in Kenya and Uganda. The TDF2 trial involved 1219 men and women in
Botswana.
The studies looked at both tenofovir or tenofovir plus emtricitabine (Truvada) and found that each,
when taken in advance by the HIV-negative partner as a pre-exposure prophylaxis (PrEP), can prevent heterosexual transmission
of HIV from men to women and from women to men.
"The results of these studies highlight yet again the essential role of affordable ARVs in prevention.
They are a major breakthrough allowing a new vision on current prevention efforts," says Kevin Moody, International Coordinator
and CEO of the Global Network of People Living with HIV. "Recently we learnt from the HPTN052 study that antiretrovirals
taken by people living with HIV reduce the risk of HIV transmission to the HIV-negative partner. Now we have evidence
of an additional ARV-based prevention tool that allows a person not living with HIV to protect themselves from
contracting HIV."
The full potential of this new HIV prevention tool will only be realised once cost is not a barrier
to access. Provision of antiretrovirals for PrEP must not come at the expense of scaling up treatment programmes for those
who do need treatment. Furthermore, consideration must be made of how to deliver PrEP and monitor the health of people
taking it, especially in settings with overburdened health systems.
GNP+ calls on the World Health Organization and Joint United Nations Programme on HIV/AIDS to ensure guidance is
developed and published for individuals and couples on how to make informed decisions about the HIV prevention options that
work best for them, as well as guidance for those providing services to those in need to access ART and PrEP. This guidance
should be developed in collaboration with networks of people living with HIV and key populations. Information about the
benefits and risks involved in taking antiretrovirals, and skills to discuss and negotiate the various options, are
essential for good adherence to both prevention and treatment.
Serious concerns remain about the long-term health effects for HIV-negative people when taking antiretrovirals
for HIV prevention. The studies now published used standard daily doses of tenofovir and Truvada, but more research is
needed to determine whether lower doses or intermittent dosing might be as effective and if they may improve
long-term safety, adherence and reduce costs.
The impact PrEP might have on ARV resistance is yet to be determined, but it is likely that people unaware
that they are already living with HIV will develop resistance when taking PrEP. To better manage this risk, there should
be dramatically increased access to high quality human rights-based HIV testing, counselling and support services, since
individuals taking PrEP will need to test on a regular basis. In-depth and ongoing research remains necessary in order
to support individuals and couples to make informed decisions.
In jurisdictions where HIV exposure and/or transmission are criminalised, the use of antiretrovirals for HIV prevention
by either HIV-positive or HIV-negative people, or both, potentially transforms the ethical and legal landscape in terms
of 'shared responsibility' to prevent new infections. Supportive policy and legal environments are essential to enable
individuals living with HIV, as well as those at risk of HIV from key population groups, to benefit from the full
potential of these new prevention technologies, without fear of (further) criminalisation.
End notes
The Global Network of People living with HIV (GNP+) is a global network for and by people
living with HIV. GNP+ advocates to improve the quality of life of people living with HIV. The central theme for the work
of GNP+ is Reclaiming Our Lives! GNP+ programmes are organised under four platforms of action: Empowerment; Positive
Health, Dignity and Prevention; Human Rights; and Sexual and Reproductive Health and Rights.
More information about this news release:
Please contact
GNP+ (Georgina Caswell, Programme Officer,
by email gcaswell@gnpplus.net )
"Reproduced with permission - Global Network of People living with HIV (GNP+)"
Global Network of People living with HIV (GNP+)
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