Washington, DC — The Global HIV Prevention Working Group released its third report today, recommending the integration of HIV/Aids treatment and prevention programs to reduce the rate of HIV transmission and treat those already infected with HIV, an effort they say requires tripling current HIV/Aids spending over the next three years.
The Working Group is a panel of nearly 50 public health experts, researchers and people affected by HIV/Aids, brought together by the Bill & Melinda Gates Foundation and the Henry J. Kaiser Family Foundation.
"We know from examples in developed countries, where access to treatment has existed for a while, that we are starting to see increases in HIV infection as the priority shifts from prevention to treatment," said Helene Gayle, co-chair of the Working Group and director of HIV, TB and Reproductive Health at the Bill & Melinda Gates Foundation. "So clearly, we can't let down our guard."
The report, "HIV Prevention in the Era of Expanded Treatment Access," recommends doubling current HIV/Aids prevention and treatment funding to at least $10.5 billion in 2005, increasing to $15 billion in 2007. Last year, HIV-related funding totaled $4.7 billion, according to UNAIDS.
Many countries hardest hit by HIV have already begun rolling out anti-retroviral treatment programs or are at least considering the possibility, Gayle said. ARV drug therapies are the most common and effective drug therapy for Aids in developed countries.
This is the world's best chance to build a comprehensive response to the epidemic, she said. "With access to treatment, more people will have an incentive to get tested for HIV. So people who are positive, either those in treatment or not in treatment, will be able to have knowledge of that HIV status, and we can really help to support them in reducing their risk behaviors and reducing the risk of transmitting HIV to other people."
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Along with recommending increased spending and the integration of current HIV/Aids programs, the Working Group also proposed new approaches to treatment and prevention.
First, prevention and safer sex messages should be developed for HIV-positive people, so they can avoid transmitting the virus to uninfected partners, Gayle said. Second, prevention messages for HIV-negative people should be adapted to emphasize that ARV therapy does not cure Aids, and that patients receiving treatment can still transmit HIV.
"Our messaging has to change to incorporate the fact that HIV infection is now much more of a lifelong, incurable, but still treatable disease," Gayle said, "and that has implications about what your incentives are for staying negative, now that treatment is there."
Working group members were hopeful about the prospects for increased funding, but cautioned that the most difficult proposal in the report is integrating treatment and prevention programs.
"The big challenge is that treatment tends to be given to individual patients attending government hospitals or private sector health care services, whereas prevention tends to be run by non-medical professionals at a population level," said Dr. Salim Karim, a member of the Working Group from the University of Natal in South Africa. "So these are two different groups. What we have to ensure is that we get these groups talking to each other to find concrete strategies for integrating both their activities, and I think that's where the challenge lies."
