The STOP HIV/AIDS Project: Treatment as Prevention in the Real World
British Columbia's STOP HIV/AIDS pilot project has sparked media interest and dialogue in Canada and internationally.1-4 It represents a new approach to HIV prevention and treatment. But what is the STOP HIV/AIDS project? What are some of its strengths and why is it controversial?
Treatment as Prevention: From Theory to Practice
Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) is one of the first projects in the world that formally attempts to put the science behind "treatment as prevention" into practice: If more people living with HIV in a community are on effective anti-HIV treatment, the "community viral load" will be lowered, resulting in fewer new HIV infections. This hypothesis is based on science showing that if a person living with HIV is treated for HIV effectively, their viral load will be reduced, thereby reducing the likelihood of HIV transmission to others. If the community viral load could be decreased enough, this could fundamentally alter the HIV epidemic.
Since researcher and director of the BC Centre for Excellence Julio Montaner and his team proposed this hypothesis at the 2006 International AIDS Conference in Toronto, evidence on the effectiveness of HIV treatment as a prevention method has become stronger, with support from observational studies,5-8
As evidence has increased to support this hypothesis, there has been a growing realization that treatment as prevention might emerge as a key strategy in the global effort to address HIV. Many global leaders in HIV prevention have endorsed the science behind the theory, and pilot research projects, such as STOP, are underway to test the hypothesis.2,3,9 Given this real potential, we need to understand not only the science but also the real-world experience of the STOP project, as one of the first attempts to implement a large-scale combination HIV prevention and treatment program.
What Is STOP HIV/AIDS?
STOP HIV/AIDS is a four-year pilot project with $48 million of funding from the government of British Columbia. This project aims to increase the quality of life for people living with HIV and to reduce the number of new HIV infections by taking a proactive public health approach to finding people living with HIV, bringing them into HIV treatment programs and supporting them to stay on treatment.4,10
STOP, which is being rolled out in Vancouver and Prince George, is made up of numerous interconnected and discrete community-based, clinic-based and policy-focused programs implemented through the collaboration of an impressive number of stakeholders. Key partners include the British Columbia Ministry of Health Services, the B.C. Centre for Excellence in HIV/AIDS, Providence Health Care, and three health authorities: Vancouver Coastal Health, Northern Health and Provincial Health Services Authority. To ensure that individuals in Vancouver are provided with the most comprehensive care possible, Vancouver Coastal Health and Providence Health Care have joined forces to become the "Vancouver STOP HIV/AIDS Project". This means that they work collaboratively and co-lead the implementation of STOP in this city.
Representatives from these organizations, along with representatives from some First Nations communities in the province and the HIV "community" in Vancouver and northern B.C., make up the Leadership Committee, a group that is ultimately responsible for the implementation of the project.
These partners play different roles in the project. The B.C. Ministry of Health Services is the funding organization, the B.C. Centre for Excellence is responsible for research and the overall evaluation of STOP goals, and the Vancouver STOP Project players, Northern Health and the Provincial Health Services Authority are responsible for implementation "on the ground," either through the creation of their own programs or through the funding of external projects.
The input of B.C. community organizations and individuals living with HIV is critical to the success of the STOP project; many of the programs that contribute to its overall goals are implemented by community-based organizations.
STOP Implementation: Is This All About "Seeking" and "Treating"?
Treatment as prevention is sometimes referred to as "seek and treat": "seek" meaning outreach and testing to increase the number of people who know they are HIV positive, and "treat" meaning putting people on treatment when clinically warranted and when people are ready to start. But treatment as prevention programs need to be far more complex than merely "seeking" and "treating." Treatment as prevention programs must be implemented through a rights-based framework and address individual and community needs across the full continuum of care, which not only includes "seeking" and "treating" but also prevention, care and support.11
STOP activities can be categorized under four headings:
By effectively implementing activities within these four areas in multiple settings and by ensuring collaboration across all stakeholder groups, STOP could have a significant effect on the lives of individuals living with HIV and the number of new HIV infections.
This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication Prevention in Focus: Spotlight on Programming and Research. Visit CATIE's Web site to find out more about their activities, publications and services.
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