Suchergebnisse

Prevention of HIV infection has recently acquired new effective tools, based on the provision of antiretrovirals, to both decrease the "source" of HIV infection and/or to decrease host susceptibility to HIV infection. The milestone concept of using antiretrovirals for prevention has been tested already in the 1990s, to interrupt maternal–child. The suggestion of using antiretrovirals to decrease inter‐human HIV transmission was born already in 2006, and definitely proven by a randomized controlled study on HIV‐discordant couples demonstrating an astonishing 96% efficacy, and with numerous studies proving the efficacy of pre‐exposure prophylaxis. It now appears clear that antiretroviral therapy not only provides clinical benefit to the individual (although the exact starting time remains controversial, in terms of risk‐benefit ratio and public health policy) but has the potential of decreasing the incidence of new infections at a population level. The concept of Treatment as Prevention is now gaining momentum, as a way to progressively end the AIDS epidemic by expanding the access to antiretrovirals, with "test and treat" being the ultimate possibility, although not already tested in the field and with huge implementation barriers. The presentation will deal with successes, failures, and foreseen barriers of using antiretrovirals for prevention, at the individual and population level, also including the social issues, the need to target key‐affected populations, and, finally, the perspectives of new technologies under development.

IntroductionScientific research has demonstrated the clinical benefits of earlier initiation of antiretroviral treatment (ART), and that ART can markedly reduce HIV transmission to sexual partners. Ensuring universal access to ART for those who need it has long been a core principle of the HIV response, and extending the benefits of ART to key populations is critical to increasing the impact of ART and the overall effectiveness of the HIV response. However, this can only be achieved through coordinated efforts to address political, social, legal and economic barriers that key populations face in accessing HIV services.DiscussionRecent analyses show that HIV prevalence levels among key populations are far higher than among the general population, and they experience a range of biological and behavioural factors, and social, legal and economic barriers that increase their vulnerability to HIV and have resulted in alarmingly low ART coverage. World Health Organization 2014 consolidated guidance on HIV among key populations offers the potential for increased access to ART by key populations, following the same principles as for the general adult population. However, it should not be assumed that key populations will achieve greater access to ART unless stigma, discrimination and punitive laws, policies and practices that limit access to ART and other HIV interventions in many countries are addressed.ConclusionsRights‐based approaches and investments in critical enablers, such as supportive legal and policy environments, are essential to enable wider access to ART and other HIV interventions for key populations. The primary objective of ART should always be to treat the person living with HIV; prevention is an important, additional benefit. ART should be provided only with informed consent. The preventive benefits of treatment must not be used as a pretext for failure to provide other necessary HIV programming for key populations, including comprehensive harm reduction and other prevention interventions tailored to meet the needs of key populations. An end to AIDS is only possible if we overcome the barriers of criminalization, stigma and discrimination that remain key drivers of the HIV epidemics among key populations.