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An Ounce of Treatment Is Worth a Pound of Prevention

By Phill Wilson

May 19, 2011

Phill Wilson

As we prepare to commemorate 30 years since the first AIDS case was diagnosed in America, we now have the tools that could end the HIV pandemic.

Last week the National Institute of Allergy and infectious diseases (NIAID) at the National Institute of Health (NIH) released the results of a historic study demonstrating the efficacy of treating HIV patients with antiretroviral drugs as a method of HIV prevention.

The study involved 1,763 couples in which one partner was HIV negative (not infected with HIV); the other partner was HIV positive (infected with HIV). All of the HIV positive participants had a T-cell count -- a measure of their immune system's strength -- of between 350 and 550. The participants were randomly divided into two groups. One group started on antiretroviral treatment right away, while researchers delayed treatment for the other group until the HIV-positive partner exhibited symptoms of an AIDS-related illness or his or her T-cells fell to 250 (the recommended time to start antiretroviral therapy for most of the world at the time the study began). All participants were given condoms and provided HIV- and STI-prevention services.

During the study's 6-year duration, 28 infections were genetically linked to the HIV-positive partner. Of those, 27 occurred in the group whose treatment was delayed; only one took place in the group where treatment had been started right away. This suggests that if a person with HIV takes antiretroviral (ARV) treatment they are 96 percent less likely to pass on the virus than someone who is HIV-negative and not taking preventive ARVs.

These findings definitively end the previous debate about whether to invest in prevention or treatment. There is no longer a "prevention strategy"; there is no longer a "treatment strategy." From now on there should only be a coordinated "end the AIDS epidemic strategy"; for if the results of this study are confirmed, treatment is prevention!

These results come on the heels of promising clinical trial findings about the efficacy of vaginal microbicides for women and pre-exposure prophylaxis for men who have sex with men.

We have reached a deciding moment: HIV is 100 percent preventable, 100 percent diagnosable and in many cases treatable. Our prevention toolbox is now exploding with options. We now have the tools to end the AIDS epidemic!

But the question remains whether we have the political will to invest in using these tools strategically, effectively and compassionately.

It's time to call on Congress, the Obama Administration, and federal and state agencies to do three things:

  1. Invest in expanded access to testing and linkages to care.
  2. Increase access to care for vulnerable communities including the ADAP waiting lists.
  3. Raise HIV science and treatment literacy in vulnerable communities.
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People need to know their HIV status, and those who are HIV positive need to be linked to appropriate care immediately.

Federal and state governments must address the ongoing funding crisis facing the AIDS Drug Assistance Program (ADAP), which provides HIV-related prescription drugs to those who are underinsured or without insurance. Over 30 percent of all people diagnosed with AIDS are enrolled in ADAP. Over 60 percent are uninsured, and 55 percent are black or hispanic.

Nationally nearly 8000 people remain on ADAP waiting lists. Fourteen states have reduced the number and types of drugs they will pay for. A number of states have stiffened financial eligibility requirements, capped enrollment or removed some people who were already enrolled. Other states are considering doing the same.

This approach is outrageous. Not only are such cuts immoral and financially shortsighted, as these recent data prove, starving ADAP programs creates a public health threat.

We also need to finally invest in HIV treatment education in vulnerable communities. HIV health disparities are growing in the U.S., and black people are disproportionately impacted. Black Americans become infected at a younger age and at higher rates, are diagnosed at a later point in their disease and die faster than any other racial ethnic group. Our lack of scientific understanding about how the virus behaves in the body and what options exist to treat it is one of the biggest barriers to efforts to confront HIV in our communities.

Lacking this knowledge too many of us in the black community become distracted by myths and misinformation. When we don't understand the science of HIV/AIDS, we are unable to protect ourselves, we put off getting tested, delay starting treatment, fail to adhere to the treatment regimens and are reluctant to own the disease and/or our responsibility for ending it.

If we don't raise HIV-related science literacy, capacity and infrastructure in black communities, black people will continue to be left behind, and we won't succeed in ending the disparities, despite the biomedical advances we're making.

As the saying goes, "An ounce of prevention is worth a pound of cure." We may have reached a time where we can get both a pound of prevention and a pound of cure/treatment on the same dime -- if only we're willing to spend the dime.




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