Volume 11 Number 2 2014
Antiretroviral-based Prevention of HIV
SH14071Bringing new HIV infections to zero – opportunities and challenges offered by antiretroviral-based prevention in Asia, the Pacific and beyond: An overview of this special issue
This editorial describes the contents of this special issue of Sexual Health devoted to implementing new antiretroviral-based prevention approaches in Asia, the Pacific and beyond. Recent discoveries have opened new opportunities for HIV biomedical prevention, and countries committed to deploy new interventions and scale-up responses to HIV. This issue is dedicated to presenting research and promoting debate regarding opportunities and challenges of moving prevention innovations into the community in the region
SH13056Transforming Australia’s HIV prevention and treatment efforts to achieve an AIDS-free generation: the United Nations Political Declaration on HIV/AIDS and the Melbourne Declaration ‘Action on HIV’
Scientific advances in HIV prevention and treatment, together with the 2011 United Nations Political Declaration on HIV/AIDS, offer unique opportunities to transform the global fight against AIDS. However, progress in responding to these opportunities has been mixed, prompting Australian scientists, clinicians and community advocates to issue the Melbourne Declaration ‘Action on HIV’, which calls for Australia’s HIV response to be revitalised through several key actions. These changes can strengthen Australia’s HIV response domestically and also enhance Australia’s leadership in the global quest to achieve an ‘AIDS-free generation’.
SH13116'Getting to zero' in Asia and the Pacific through more strategic use of antiretrovirals for HIV prevention
The strategic use of antiretrovirals is critical to ending AIDS in Asia. Nevertheless, low rates of HIV testing among men who have sex with men, people who inject drugs, sex workers and other key populations evidence low treatment coverage where treatment could have the greatest prevention benefits. Enhanced collaboration is needed between clinical and community service providers to reach, test, treat and retain key populations in care.
Access to HIV treatment and care vary between countries in Asia and the Pacific. Differences between high-income economies and the rest of the region are remarkable. Many high-income countries provide antiretroviral therapy (ART) to their citizens; middle- and low-income countries have rapid ART scale-up and are dependent on international funding. The global goal of achieving universal access to ART requires mainly low- and middle-income countries to be targeted.
SH13094Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region
The effectiveness of antiretroviral therapy taken by HIV-infected individuals to prevent HIV transmission to HIV-uninfected persons (TasP) and antiretroviral pre-exposure prophylaxis taken by HIV-uninfected individuals to prevent HIV acquisition (PrEP) is unknown in HIV epidemics concentrated in populations at high risk for HIV. This paper investigates the challenges and barriers of implementing TasP and PrEP in the Asian context and makes the case that implementation research in Asia can provide data on the effectiveness of such interventions in concentrated epidemics.
SH13142Can treatment-based HIV prevention curb the epidemic among gay and other men who have sex with men? A narrative synthesis of increasing evidence for moderating and countervailing effects
As HIV epidemics among gay and other men who have sex with men (GMSM) persist, there is hope that the use of antiretroviral therapy (ART) for prevention can curb infections. However, evidence of the beneficial effects of ART-based HIV prevention for GMSM remains limited. ART-based approaches increase people’s options to protect themselves and others, but their impact depends on what has already been achieved and how they will be used.
A model is used to simulate the expected outcomes of treatment-as-prevention strategies in Australia under assumptions of varying levels of treatment efficacy.
SH13104The key role of adherence for the effectiveness of antiretroviral-based prevention: state of the science and implications for the Asia-Pacific region
This paper reviews the behavioural factors influencing uptake and impact of treatment-as-prevention and pre-exposure prophylaxis. The behavioural pathways to control the HIV epidemic with these biobehavioural strategies are explored, and gaps in current knowledge are identified. Implications for each strategy in the Asia-Pacific region are considered, and critical issues in moving forward are highlighted.
SH13060HIV pre-exposure prophylaxis and treatment as prevention: a review of awareness and acceptability among men who have sex with men in the Asia-Pacific region and the Americas
This review assesses acceptability research for HIV pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) among men who have sex with men (MSM). There has been limited research on the acceptability of PrEP outside the United States and no research to date evaluating the acceptability of TasP. PrEP appears to be reasonably acceptable to MSM, but studies of HIV treatment optimism suggest that MSM will be sceptical of TasP.
SH13067Acceptability of oral and topical HIV chemoprophylaxis in India: implications for at-risk women and men who have sex with men
The underlying determinants for acceptability of HIV chemoprophylaxis include the individual, couple dynamics and the larger social and cultural context. Overall, Indian women and men had a positive attitude towards the concept and use of microbicide products. However, the need for HIV chemoprophylaxis is greatest for high-risk groups like female sex walkers and men who have sex with men. Acceptability in these groups needs to be further explored, including demonstration projects for program introduction.
SH13119Biomedical HIV prevention research and epidemic control in Thailand: two sides of the same coin
This paper revisits Thailand’s global role model function of effective HIV/AIDS control and high-quality biomedical HIV prevention research. Results indicate that Thailand’s initial response in raising the level of the political significance of HIV/AIDS was indeed extraordinary, but its effectiveness declined over time. However, the volume and quality of the country’s biomedical HIV prevention research continued to be high. Thailand has made a huge contribution to the global management and control of the HIV/AIDS pandemic.
In recent years there has been increasing evidence that early initiation of antiretroviral therapy may provide health benefits for those infected with HIV while also reducing the risk of onward transmission of the virus. Recently-diagnosed gay men, interviewed as part of the HIV Seroconversion Study, were asked about their knowledge and experience of, and their decisions about whether or not to commence, HIV treatment.
SH14064Rolling out new biomedical HIV prevention tools: what can be learned from Avahan, the India AIDS initiative?
The promise of new biobehavioural prevention advances, namely pre-exposure propyhlaxis (PrEP) and treatment as prevention, for key populations can only be realized if they are implemented with adequate scale and coverage. Globally, coverage of key populations with classic prevention services is inadequate and they have limited access to health services in many settings. The approaches used by Avahan in India to achieve a scaled prevention intervention with high coverage and key population engagement that served as a platform for increasing service scope to expand clinical services over time services are discussed. Key elements included clear service definitions and denominator-based targets, robust and routine data systems, multilevel supervision and cross-learning, as well as a strong cadre of key population peer outreach workers who addressed structural barriers and provided mechanisms for interaction between the key populations and health services.