Bill and Melinda Gates Foundation HIV Prevention Report

[Guest guest]

Global AIDS Experts Call For Major Shift in Approach to HIV

Prevention as Treatment Access Expands

Press Release, 6.10.2004

New report highlights window of opportunity to simultaneously

expand HIV treatment and prevention

The Global HIV Prevention Working Group today issued the first

major report to examine global HIV prevention needs in a time of

expanding treatment access. The report, HIV Prevention in the Era

of Expanded Treatment Access, cites an unprecedented opportunity to

forge a comprehensive response to the global AIDS epidemic by

integrating HIV prevention interventions into expanding treatment

programs.

" This is the best chance the world has had to build a comprehensive

response to the global epidemic. More widespread access to

treatment is likely to bring millions of people into health care

settings, providing new opportunities for health care workers to

deliver and reinforce HIV prevention messages, " said Helene D.

Gayle, MD, MPH, co-chair of the Working Group, and director of HIV,

TB and Reproductive Health at the Bill & Melinda Gates

Foundation. " Now is the time to act, as treatment programs are

being launched an expanded. "

New Challenge: Potential for Increased Risk Behavior

In the report, the Working Group, an international panel of nearly

50 AIDS experts, voices concern that HIV treatment availability

could shift attitudes about the threat of HIV/AIDS in the

developing world, potentially resulting in increased risk behavior

and the continued expansion of the global AIDS epidemic. The report

recommends that HIV prevention strategies and messages be adapted

to stress the importance of continued risk reduction in the context

of expanded treatment access.

" Treatment access in the developing world will improve the lives of

millions, but also presents new challenges to HIV prevention, " said

Serwadda, MBChB, MPH, of the Institute of Public Health at

Makerere University in Kampala, Uganda, and co-chair of the Working

Group. " In Uganda, we have seen how HIV prevention can work, and we

are now undertaking a major effort to incorporate prevention

counseling into treatment programs. The goal is to ensure that

treatment does not have the unintended consequence of increasing

risk behavior. "

The report summarizes experience in industrialized countries, where

treatment access expanded without an accompanying shift in

prevention strategies, and risk behavior and new infections

increased. The report also cites projections which suggest that

even a modest increase in risk behavior in the developing world as

a result of treatment access (e.g., a decrease in condom use of

10%) could substantially accelerate the global epidemic.

Early Success in Integrating Prevention and Treatment

The report documents early successes in developing countries that

embarked on coordinated prevention and treatment programs, such as

Brazil, Botswana, Haiti, and South Africa. For example, Brazil

implemented aggressive prevention and treatment programs early in

the epidemic, and saw HIV testing rates and ART use increase

substantially, while reducing rates of risk behavior. A project by

Médecins Sans Frontières in the Khayelitsha township in South

Africa couples prevention counseling with ART provision, resulting

in increased rates of condom use in the community.

Need to Increase HIV Testing Rates

Because increased HIV testing rates are critical to both treatment

and prevention efforts, the report also calls for HIV testing to be

universally offered in all health care settings in areas where ART

is available with the option to opt out for those who donâ??t want

to be tested. Experts estimate that today only 10 percent of HIV-

positive people in developing countries are aware of their

infection.

Limited Access to Proven HIV Prevention Interventions

As the Working Group reported last year, globally, fewer than one

in five people at high risk of HIV infection have access to proven

prevention interventions like condoms, voluntary HIV counseling and

testing, behavior change programs, drugs to prevent mother-to-child

transmission, and harm reduction programs for injection drug users.

" Our latest survey shows that the majority of Americans now believe

that spending more money on prevention in Africa and developing

nations will lead to meaningful progress, " said Drew Altman, PhD,

President and CEO of the Henry J. Kaiser Family Foundation, and co-

convener of the Working Group. " The challenge now is to make

scaling up our number one priority in the fight against HIV, and to

scale up prevention and treatment in tandem. "

The report argues that unless the incidence of HIV infection is

sharply reduced, treatment will not be able to keep pace with all

those who will need therapy. For example, while WHO and UNAIDS have

established the goal of having 3 million people on anti-retroviral

therapy by 2005, 5 million new infections occur every year.

The Working Group calls for annual funding for HIV prevention and

care to increase from $4.7 billion in 2003 to $10.5 billion in 2005

and $15 billion in 2007, as recommended by UNAIDS.

Recommendations

The Working Group report lays out a four-point plan of action:

1. Integrate HIV Prevention and Treatment

Provide HIV Prevention in ART & Other Health Care Settings: All

health care settings, including HIV treatment sites, should deliver

HIV prevention counseling, condoms and other interventions. In

addition to free-standing voluntary counseling and testing sites,

HIV prevention counseling and testing should be offered in STD and

TB clinics, hospitals, family planning and reproductive health

centers, substance abuse clinics, and prenatal clinics, among

others.

Expand Access to HIV Testing & Universally Offer Testing Where ART

Access Exists: Testing programs should be significantly expanded

and aggressively promoted. Where ART access exists, HIV testing and

counseling should be universally offered in all health care

settings with the option to opt out for people who donâ??t want to

be tested.

2. Develop Prevention Strategies for HIV-Positive People

" Prevention for Positives " : New prevention programs tailored to the

needs of people living with HIV should be developed and

implemented. Such programs would include counseling regarding

disclosure of HIV status to partners, education about the ability

of people to transmit HIV even while on ART, and counseling to

address obstacles to safer behavior.

Involve People Living with HIV: Donors and governments should

provide financial support to organizations of people living with

HIV, who should be actively engaged in the delivery of HIV

prevention services to HIV-positive people.

Fight Stigma: Enforceable laws must be in place to protect people

with HIV from discrimination, and community-based initiatives to

empower people with HIV should be implemented.

3. Adapt Prevention for HIV-Negative People

New Messages: New strategies must emphasize the continued

importance of risk reduction. " Treatment literacy " programs should

emphasize that ART is not a cure, and that people on ART can still

spread the virus to their partners.

Monitoring Impact: Surveillance systems should closely monitor the

behavioral impact of ART.

4. Fund a Comprehensive Response

Simultaneous Scale-Up of Prevention and Treatment: HIV/AIDS

spending from all sources should increase from $4.7 billion in 2003

to $10.5 billion in 2005 and to $15 billion in 2007, as recommended

by UNAIDS.

Research: Funding for research into a broad array of potential

prevention technologies must increase. By 2007, annual research

funding should roughly double to $1 billion for HIV vaccines and to

$300 million for microbicides.

About the Working Group

The Global HIV Prevention Working Group is a panel of nearly 50

leading public health experts, clinicians, biomedical and

behavioral researchers, and people affected by HIV/AIDS, convened

by the Bill & Melinda Gates Foundation and the Henry J. Kaiser

Family Foundation. The Working Group seeks to inform global policy-

making, program planning, and donor decisions on HIV prevention,

and to advocate for a comprehensive response to HIV/AIDS that

integrates prevention and care. In July 2002, the Working Group

issued its first report, Global Mobilization for HIV Prevention: A

Blueprint for Action. In May 2003 it released Access to HIV

Prevention:Closing the Gap. Both are available at

http://www.gatesfoundation.org/ and http://www.kaisernetwork.org/.

To access the report, cut and paste link:

http://mail.unfpa.org/attach/PWG2004Report.pdf?

sid=aAywoYeA+BE & mbox=INBOX & charset=escaped_unicode & uid=249 & number=3 &

filename=PWG2004Report.pdf

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Contact:

Milbank

Phone: +1-212-584-5022

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Joya Banerjee

Intern, HIV/AIDS Branch

UNFPA

banerjee@...

212.945.8071