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Article << Previous     |     Next >>   Contents Vol 11(2)

‘Getting to zero’ in Asia and the Pacific through more strategic use of antiretrovirals for HIV prevention*

Michael M. Cassell A F , Timothy H. Holtz B C , Mitchell I. Wolfe B D , Michael Hahn E and Dimitri Prybylski B D

A US Agency for International Development, 6th Floor, Tung Shing Square, #2 Ngo Quyen, Hanoi, Vietnam.
B Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, Floor 3–5, 7th Bldg, Department of Disease Control, Ministry of Public Health, Soi 4 Tivanon Road, Nonthaburi 11000, Thailand.
C Division of HIV/AIDS Prevention, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA.
D Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA.
E Joint United Nations Programme on HIV/AIDS, Thailand Country Office, 12th Floor, Block A, United Nations Building, Rajdamnern Nok Avenue, Pranakorn Bangkok 10200, Thailand.
F Corresponding author. Email: mcassell@usaid.gov

Sexual Health 11(2) 107-118 http://dx.doi.org/10.1071/SH13116
Submitted: 27 July 2013  Accepted: 30 April 2014   Published: 19 June 2014


 
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Abstract

Encouraged by experimental trials demonstrating the efficacy of antiretrovirals (ARVs) in preventing HIV infection, countries across the Asia-Pacific region have committed to the achievement of ambitious targets tantamount to ending AIDS. The available data suggest that some countries still can make progress through targeted condom promotion and the expansion of harm-reduction interventions, but that none may realise its vision of ‘zero new HIV infections’ without more strategic use of ARVs as part of a combination of HIV prevention efforts targeting key populations. 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 impact on curbing local epidemics. Studies have demonstrated the promise of adding ARV treatment and pre-exposure prophylaxis to the existing HIV prevention toolkit, but achieving population-level impact will require service-delivery approaches that overcome traditional prevention, care and treatment program distinctions. Priorities include: (1) innovative strategies to reach, test, treat and retain in services the individuals most likely to acquire or transmit HIV; (2) task shifting and enhanced partnerships between the public sector and civil society; (3) improved ‘cascade’ data systems to assess and promote service uptake and retention; and (4) policy and financing reform to enhance HIV testing and treatment access among key populations.

Additional keywords: AIDS, at-risk populations, epidemic, pre-exposure prophylaxis, treatment as prevention.


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