The fundamentals of HIV treatment provision: eight global HIV advocacy groups release consensus statement at the International AIDS Conference
Durban, 15 July 2016
The HIV epidemic could become a thing of the past, as long as everyone involved in providing HIV drugs as treatment and as prevention sticks to a few basic principles respecting the rights of people with or at high risk of HIV, eight global HIV treatment advocacy organisations announced today on the eve of the 2016 International AIDS Conference.
AVAC, the European AIDS Treatment Group (EATG), the Global Forum on MSM & HIV (MSMGF), the Global Network of People living with HIV (GNP+), HIV i-Base, the International HIV/AIDS Alliance, the International Treatment Preparedness Coalition (ITPC) and NAM/aidsmap have released the Community Consensus Statement on Access to HIV Treatment and its Use for Prevention as a sign-on statement at www.hivt4p.org for endorsement by as many people working with and affected by HIV as possible.
Simon Collins, advocate at HIV i-Base says, “This clear community demand for the right for universal access to ART is an essential step to achieving our common goal to end AIDS.”
Sixteen years ago, the International AIDS Conference was also held in Durban. That ground-breaking conference woke the world to the fact that providing HIV treatment to people in under-resourced countries was not only lifesaving and a matter of global justice, it was, even more importantly, feasible.
Since then, in what is one of the most remarkable medical initiatives of all time, HIV treatment has expanded to the point where 2016 will be the year that more than half of the people in the world who need HIV treatment get it.
But that still leaves nearly half the world in danger of dying from AIDS, and that need is concentrated among certain regions such as the Middle East and eastern Europe and among certain groups such as people who inject drugs.
In addition, although people on treatment are less infectious, the number of HIV cases continues to rise among some groups, most notably men who have sex with men.
Why? Partly it is due to the number of people still in need of treatment; equally, however, it is because those unreached by treatment or appropriate prevention belong to already-stigmatised groups likely to be stigmatised further if it is known they have HIV.
“While in practice, getting HIV treatment to those who need it may involve considerable expense, logistical challenges and a re-modelling in healthcare services,” says NAM/aidsmap’s Gus Cairns, who helped write the statement, “in principle, it’s not complicated”.
“At heart, the statement says two things: Don’t withhold HIV treatment; equally, don’t enforce it. People have the right to treatment, but also the right to the information and freedom they need to take it as a choice.”
The statement is written as 40 short sentences in deliberately simplified English, spelling out basic principles to be observed in extending HIV testing, treatment and drug-based prevention to all.
The statement emphasises that treatment should be free and offered to everyone with HIV without coercion. Information about treatment and support to take it should be available for everyone. Income, gender, sexuality, age, drug use or social status should not prevent people from getting antiretroviral treatment (ART).
The statement also covers the use of antiretroviral drugs by people who are HIV-negative to prevent HIV infection, known as pre-exposure prophylaxis or PrEP. The option to use PrEP should be available for all people who need it and information about PrEP should be available to all people at risk of HIV infection. PrEP should be offered now to those at high risk of HIV infection, the statement recommends.
“We wanted to hold people’s feet to the fire in the world of HIV,” Cairns continues, “and say essentially, ‘If you can’t agree to this, why not?’ We’d like to see it adopted by the organisations that write treatment guidelines and run programmes as a sort of DNA for what they are doing, the basic principles underlying and directing their actions.”
Notes for editors
The following organisations have been involved in writing this statement:
European AIDS Treatment Group (EATG) www.eatg.org
Global Forum on MSM & HIV (MSMGF) http://msmgf.org
Global Network of People living with HIV (GNP+) www.gnpplus.net
HIV i-Base http://i-base.info
International HIV/AIDS Alliance www.aidsalliance.org
International Treatment Preparedness Coalition (ITPC) http://itpcglobal.org
Two years ago, NAM and EATG, with the support of a number of other organisations, released the Community consensus statement on the use of antiretroviral therapy in preventing transmission. This went through a year’s worth of development and was released as a sign-on statement. This new statement is a simpler, more fundamental and more widely co-authored development of that.
Why a new statement?
The science surrounding the use of antiretrovirals to prevent HIV, as well as policy and activism, have moved rapidly over the last two years. In particular, there is now broad consensus for the first time that antiretroviral therapy is both of general medical benefit to people with HIV and, if provided globally, could drastically reduce the HIV infection rate worldwide. In addition, there is increasing awareness of and debate about the use of antiretroviral drugs as PrEP, to prevent infection in HIV-negative people at the highest risk of HIV infection.