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Treatment as Prevention: Report back from the Vancouver Workshop

Treatment as Prevention: Report back from the Vancouver Workshop . How treatment as prevention affects individuals: perspective from community Eric Fleutelot – Sidaction . TasP: a revolution. Community mobilization: a key role in successes of HIV prevention, care, treatment and support

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Treatment as Prevention: Report back from the Vancouver Workshop

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  1. Treatment as Prevention: Report back from the Vancouver Workshop How treatment as prevention affects individuals: perspective from community Eric Fleutelot – Sidaction

  2. TasP: a revolution • Community mobilization: a key role in successes of HIV prevention, care, treatment and support • TasP: perceived as a prevention revolution • Hope and relief • Potentially could endanger good practice

  3. What kind of revolution ? • French revolution-like : • Eventually less power to the people, • A new elite becoming more powerful (health leaders and theory guys of public health) • A democratic revolution • For and by people living with HIV, finally freed from the fear to pass virus to partners

  4. A revolution for the people • Effectiveness of treatment in the prevention of HIV transmission • Non sexual transmission: • Vertical transmission • IDUs • Sexual transmission • HPTN 052 being the latest example • TasP affects individuals tremendously: • PLHIV no longer infectious • New counselling in a risk-reduction approach • Easier to plan pregnancy

  5. TasP • An opportunity to discuss about people living with HIV’s sexuality • Means earlier treatment • Advantages for individuals: • Better immune and virological outcomes, • Fewer aids-related diseases, • Reduced mortality and better survival expectancy, • But we need to be sure it’s a clear benefit. • HIV, a chronic disease, but not like others • High level of stigma

  6. Implementing TasP • Numerous challenges • High level of stigma and discrimination • Hard to disclose • HIV highly prevalent among discriminated and marginalized people • IDUs, MSM, sex workers, inmates, … • Real world does not stick to mathematical models

  7. Challenges • 60% of HIV+ aware of their HIV status not linked to care RethinkingPrevention of HIV Type 1 Infection, David N. Burns, Carl W. Dieffenbach, and Sten H. Vermund, ClinicalInfectiousDiseases, Volume51, Issue6 Pp. 725-731. • In Burundi: • 250 000 HIV+ people, • 60 000 should be on HAART, • 23 000 are actually on HAART.

  8. Challenges (2) • GNP+ statement after HPTN 052 was made public: • “…, in order to realize both the individual and public health benefits of treatment, it is important that the rights of people living with HIV are recognized and protected.” • Every individual should decide when and how to start a treatment.

  9. Challenges (3) TasP could be used to convince political and financial leaders to invest more in access to care and treatment, but we have to ensure that No one is forced to get tested or is tested without their consent or coerced into starting ART primarily for the benefit of public health rather than the health and well-being of the individual.

  10. Recommendations • Review counseling and medical for • Sero-discordant couples • Pregnant positive women • For the general population • Focus more on • MSM, Sex-workers, IDUs, inmates, • Anal sex (both in homosexuals and heterosexuals)

  11. Recommendations (2) • Policy questions and behavioural research questions: • impact of STIs on the failures of treatment as prevention (especially in contexts were STIs are highly prevalent) • Criminalization of HIV transmission • Sexual behavior

  12. Thanks to my colleagues and friends • All my colleagues at Sidaction – France and more specially Ms. Veronica Noseda • Mr. Bruno Spire – Aides – France • Mr. Edwin J. Bernard – UK (and Germany too!) • Dr. Marie-Josée Mbuzenakamwe – Dept of Defense, US Embassy – Burundi • Ms. Jeanne Gapiya-Niyonzima – ANSS – Burundi • Mr. Gregg Gonzalves – USA • Mr. Alain Volny-Anne – EATG (Belgium) and Action Traitements (France) and much more (Martinique)…

  13. THE ITALIAN GOVERNMENT STILL OWES 260 MILLION EUROS TO THE GLOBAL FUND AND NEVER PLEDGED FOR 2011 - 2013 ITALY:KEEP THE PROMISE, NOW!FUND THE FUND, NOW! AIDS, TUBERCOLOSIS AND MALARIA WILL NOT WAIT!

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