george nisyrios | Treatment as prevention addressing the global impact of HIV
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Sep 23 2015

Treatment as prevention addressing the global impact of HIV

I have a number of HIV infected patients, both men and women, from resource poor countries.  Many of them migrated here as refugees, some are here as students, or on bridging visas pending permanent residency or rejection.

All of them are working, many are married and have kids. I think one of my patient’s has 10 kids or more to a couple of wives !

I often talk to them about their own country and standard of living and health care.

The reality is that if these patients were not sitting in front of me many would be dead or sick with AIDS.

Some, who have had their PR visa application rejected on medical grounds, and are awaiting an appeal on a bridging visa, could almost overnight go from highly advanced health care to no health care and discrimination if they return home.

There are many long standing global issues related to HIV, such as discrimination, women’s rights, testing, access to treatment, prevention of mother to child transmission etc

There are advanced global policies, driven by such bodies as the WHO and UNAIDS and many other government and NGO groups.

One significant policy which applies to first world settings as well is “treatment as prevention”.  This requires a number of issues to be overcome and achieves a number of goals such as; removing discrimination (leads to more testing and diagnosis), increased testing, increased access to health care, increased access to effective treatment and monitoring and prevention of new infections through suppression of viral loads (which acknowledges that campaigns directed at monogamy and safe sex are not entirely successful)

It has been shown in a number of studies in a range of populations that a suppressed viral load in the infected person makes it very difficult to infect another person.  And this is the premiss behind “treatment as prevention”.

Treatment as prevention also acknowledges that apart from blood tests results and clinical condition, other factors can be equally considered in placing an individual on treatment, especially in resource poor settings where treatment guidelines have historically been focussed on treating lower CD4 counts. The most significant factor includes treating an individual to prevent another individual from getting infected, which includes a sexual partner and a pregnancy.

It only takes one HIV positive patient to walk into the room with their partner who just tested HIV positive, to never forget that treatment and early intervention could have prevented a (usually) vulnerable person from becoming HIV positive.

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