Statement on ART as Prevention
Scaling down HIV requires scaling up human rights, testing and treatment
To the participants at the WHO consultation on ART as HIV prevention:
We, the undersigned organizations, are encouraged by emerging evidence that ART may be an effective means of reducing HIV incidence and applaud the attention of WHO and UNAIDS to identifying scientifically sound and innovative ways to accelerate progress toward universal access to HIV prevention, treatment, care and support services. We appreciate that exploration of ART as prevention is being undertaken with that crucial goal in mind, including significant gains in increasing the number of people who know their status and, if positive, have timely access to treatment.
We urge UN bodies, donors and researchers involved in this exploration to be mindful that people living with HIV and many who are highly vulnerable to it remain unable to gain access to HIV testing and to initiate treatment earlier, in a timely fashion, as a result of many human rights violations, as well as clinical and systemic barriers. Research models that do not adequately consider and address these barriers do a disservice to the important goal of making ART available to all as both prevention and treatment.
As noted by WHO and UNAIDS in the guidance on provider-initiated HIV testing and counseling (PITC guidance), there is ample evidence that fear of stigma, losing a job, losing relationships and social support, and losing the protection and love of family are powerful barriers to seeking HIV testing and treatment and to staying on treatment. The PITC guidance goes on to underscore the need for an enabling legal, social and health service environment.
At the clinical and health-systems level, people who test positive for HIV too often are denied timely initiation of treatment that would help them manage their illness and protect others from infection. Late initiation is due to a range of factors that require greater research and exploration, such as lack of free diagnostics, onerous pre-treatment requirements, lack of support to adherence counselors (many of whom are volunteers), and stock-outs of essential medicines. In addition, people who test positive for HIV sometimes delay initiation themselves because of lack of access to easy to administer and better tolerated treatment.
It is neither desirable nor possible to scale up voluntary HIV testing and treatment sustainably to implement ART as prevention without addressing these human rights, clinical and health-systems challenges. Supporting and strengthening civil society organizations in affected communities in the work of creating enabling environments are crucial to achieve this goal.
We therefore urge that the following factors be integral to any planning and implementation of feasibility or pilot studies related to ART as prevention:
The key elements of rights-based HIV testing and counseling must be in place. As noted in the 2007 PITC guidance, “positive outcomes are most likely when HIV testing...is confidential and is accompanied by counseling and informed consent, staff are adequately trained, the person undergoing the test is...referred to appropriate follow-up services, and an adequate social, policy and legal framework is in place to prevent discrimination” (emphasis added).
- Any feasibility study or pilot study of ART as prevention must include an assessment of the social, policy and legal framework to address impediments to human rights protections and barriers to testing and treatment uptake before the study proceeds. Some key factors to include in such an assessment, taken from the PITC guidance’s definition of an enabling environment, are whether there are “laws and policies against discrimination on the basis of HIV status, risk behaviour and gender” that are “in place, monitored and enforced”. These should include “legal and social protections which enhance privacy, autonomy and gender equality.”
- Feasibility or pilot studies must ensure that the following conditions are in place to ensure that ART for prevention is realized within a context of universal access to prevention, treatment, care and support:
– Antiretroviral treatment is available, can be provided without undue delay following diagnosis, and
can be sustained for the lifetime of those in the study who are living with HIV.
– There is free or affordable access to a comprehensive package of prevention and treatment services,
including but not limited to male and female condoms; sterile injecting equipment for people who inject drugs; PMTCT services; comprehensive information on HIV transmission, including sexual transmission, including for women, young people and the general public; tuberculosis and STI diagnosis and treatment; nutritional support for people living with HIV; and infant feeding counseling and support.
– There are “codes of conduct for health care providers and methods of redress for patients whose rights are infringed” (PITC guidance). Methods of redress must be meaningful and monitored.
Feasibility or pilot studies must include meaningful participation of communities in which studies are planned in all stages of the work. This should include:
– Ensuring that all community members understand and have the opportunity to ask questions about
the study before the study commences.
– Ensuring that a community decision-making body representing all key stakeholders – civil society
as well as local authorities – has a meaningful role in decision-making and consultation at all stages of the work, according to the “decision maker” role defined in the principles on the Greater Involvement of People Living with AIDS (UNAIDS, 1999).
– Ensuring that the community decision-making body participates meaningfully in the assessment of the social, policy, legal and health services framework, as well as the assessment of whether ART, comprehensive prevention services, and codes of conduct are available before any research commences.
– Ensuring that reasonable costs of participating in decision-making processes related to the study as well as participating in the study are compensated.
Developing and sustaining successful treatment programs requires working respectfully with and strengthening the capacity of civil society organizations that are at the front line of treatment literacy, adherence counseling, social support, and other work with persons and communities affected by HIV. Planning for and allocating resources to support civil society organizations should be central to any study of ART as prevention.
We look forward to working with all stakeholders to ensure that the path to using ART as a tool of prevention is a true opportunity to achieve human rights-centered, universal access to HIV prevention, treatment, care and support.
Organizations:
Academia Mexicana de Derechos Humanos Acapulco Contra el SIDA
Acción Ciudadana Contra el SIDA
African Council of AIDS Service Organizations
Agencia de Noticias sobre Diversidad
Sexual AIDS Action Europe
AIDS and Rights Alliance for Southern Africa
Aid for AIDS
AIDS Foundation of Chicago
AIDS Law Project
AIDS Project Los Angeles
AIDS Saint John
AIDS Treatment Activists Coalition
AIDS Vaccine Advocacy Coalition (AVAC)
AIDS Vancouver
Alianza Latinoamericana y del Caribe en VIH y Sida por los niños, niñas y
adolescentes
Alliance Against AIDS
Allies Linked for the Prevention of HIV & AIDS
All-Ukrainian Network of PLHIV
ALUVIHSUR
American Social Health Association
Amigos Contra el SIDA
Andrey Rylkov Foundation for Health and Social Justice
Asia Catalyst
Asia Pacific Network of People Living with HIV/AIDS
Asia Pacific Coalition on Male Sexual Health (APCOM)
Asistencial Tiempo Nuevo
Asociación Coordinadora de Lucha Contra el SIDA – ACSLCS
Asociación Costarriense de Personas con VIH
Asociación de mujeres Garífunas viviendo con VIH o sida y afectadas
Asociación de Personas que Viven con VIH
Asociación Viviendo Positivamente Asociatia SENS POZITIV ASSOCIACAO KHALIDWE Association AIDES Association de lutte contre le sida (ALCS)
Association des Volontaires pour la Promotion des Jeunes
ASSOCIATION NATIONALE DE PROTECTION DES FEMMES ET ENFANTS HAITIENS
Association of Nurses in AIDS Care
Astitva Astra
ATHENA Network
Balance Promoción para el Desarrollo y Juventud
BC Persons With AIDS Society
Bulgarian Gender Research Foundation
Calmecac Alianza Ciudadana Asociación Civil
Canadian AIDS Society
Canadian AIDS Treatment Information Exchange
Canadian HIV/AIDS Legal Network
Center for Health Justice
Center for Health Policy and Innovation
Center for Reproductive Rights
Central and Eastern European Women's Network for Sexual and Reproductive Health and Rights
Centre Women and Modern World
Centro de Atención Integral en VIH-Sida
Centro de Prevención y Apoyo en VIH
Children Education Society
CILSIDA
Coalición ecuatoriana de personas que viven con VIH/sida
Coalition of Asia Pacific Regional Networks on HIV and AIDS
Coalition PLUS
Colega. O, A.C.- Sexualidades y Derechos Humanos
Columbia University
Comisión Nacional de los Derechos Humanos
Community Based Research Centre Society
Community HIV/AIDS Mobilization Project
Coordonnatrice national RIGIAC
Copperbelt Health Education Project
Creathe
Czech AIDS Help Society
Delhi Network of Positive People
Deutsche AIDS Hilfe
Empower
Era of Mercy
Estonian Network of PLHIV
European AIDS Treatment Group (EATG)
Flemish Centre for Expertise and Services on Sexual Health and HIV
Foundation Positive Women of the World
Fundación para Estudio a Investigación de la Mujer
Fundación REDVIHDA
Fundación Sin VIH-SIDA
Georgian Harm Reduction Network
Global Campaign for Microbicides
Global Forum on MSM and HIV
Global Network of People Living with HIV/AIDS (GNP+)
Groupe Chrétien Contre le SIDA au Togo
Grupo de Amigos con Vih A.C
Guyana RainBow Foundation
Health Initiative for Men
Healthy Options Project Skopje
HIV/AIDS programme Young People We Care
HIV/AIDS Services for African Americans in Alaska
HivEurope HIV-Sweden
Human Rights Watch
Hungarian Civil Liberties Union
Iglesia Católica Antigua del Río de la Plata
Instituto de Consejería y Análisis de Temperamento
Instituto para el Desarrollo Humano
Instituto SOIS
Interagency Coalition on AIDS and Development
Interfaith Youth Coalition on HIV/AIDS
International community of women living with HIV Eastern Africa
International Community of Women Living with HIV/AIDS (ICW)
International Council of AIDS Service Organizations
International Network of People who Use Drugs
International Rectal Microbicide Advocates
International Treatment Preparedness Coalition (ITPC)
INTILLA Asociación Civil
Italian League For Fighting Aids National Federation
Japan AIDS & Society Association
Japanese Network of People Living with HIV
JN+
Just Associates of Southern Africa
Kenya AIDS NGOs Consortium
Kenya Ethical & Legal Issues Network on HIV & AIDS
KidAIDS
Kimirina Corporation
Latin American and Caribbean Women ́s Health Network
Latin American Center on Sexuality and Human Rights
Latin American Council of AIDS Service Organization
Les Anges du ciel Anges du Ciel
Lesotho Treatment Literacy Coalition
Letra S
LIGA Bonaerense de Diversidad Sexual
MANOS UNIDAS POR TI QROO
Mecanismo Social de apoyo y control en VIH
MIFRO
Mosaic Training, Service & Healing Centre for Women
National MSM and HIV Policy Advocacy and Human Rights Task Force
Nicasi Esperanza Vida
NPS Italy Onlus
Odyseus
Open heart House
Open Society - Georgia Foundation's Public Health Unit
Open Society Initiative for Southern Africa
Open Society Institute's Public Health Program
Org. de Mujeres Trabajadoras Sexuales y ex Trabajadoras Sexuales Mexicanas
Pastoral Ecuménica VIH-SIDA y la Coordinación Regional del Plan de Acción en VIH y SIDA de la Federación Luterana Mundial
Philippine Forum on Sports, Culture, Sexuality and Human Rights
Planned Parenthood Federation Positive Living Association
Positive Malaysian Treatment Access & Advocacy Group
Positive Voice
Positive Wave
Positivo PREVENSUR
Prévention Information Lutte contre le SIDA
Q-Club
Red Latinoamericana de Personas Viviendo con VIH
Red Latinoamericana para la Reforma de las Políticas de Drogas REFORMA
Red Mexicana de Personas que Viven con VIH/SIDA
Red Nacional de Personas que Viven con VIH/SIDA
Red Nacional de personas Viviendo con Vih/Sida
Red Venezolana de Gente Positiva
REDCA+
Research Unit in Behaviour & Social Issues-Cyprus
Romanian Association Against AIDS
SADC Parliamentary Forum HIV/AIDS Unit
SAHRiNGON Tanzania
Secrétaire Afrique de l'ouest du Forum Francophone TB/VIH
Senderos Asociación Mutual Servicios Humanitarios en Salud Sexual y Reproductiva
Social AIDS Committee
Society Housing AIDS Restricted Persons
Surmounter
SWAPOL
Swiss aids federation
TEMA - information center
Terrence Higgins Trust
Tororo Forum for people living with HIV/AIDS networks
Treatment Action Campaign
Treatment Action Group
UDYAMA,ODISHa
Ukrainian Network PLWH
Umunthu Foundation
Vida Plena Puebla
Warning community association of gay men health and fight against HIV
Wilson Resource Center
World Care Council (India / DR Congo / France)
World YWCA
Youth Creative Network
Youth Development of Nigeria
Youth Partnership for Peace and Development
- Kristi's blog
- Login or register to post comments
Comments
From Loon on literacy
We need to know as much as possible the drugs that we pop everyday, not rely just on Doctors (with due respect to doctors) because...
Doctors may prescribe you ARV but remember they never takes even a single pill, they don’t know if it’s sweet or bitter or difficult it is, you and I do.
.........................................but they never experience any side effects, you and I do.
.........................................but they never experience any changes in their CD4 or VL, you and I do.
.........................................but they never know how easy or difficult adherence is, you and I do.
.........................................but they don’t need 2nd or 3rd or 4th or salvage therapy, you and I do ( or will do)
Our lives, our drugs, our hope, then why rely on other knowledge, but get the most update info from your doctors and your friends.
The more your are treatment literate, the better ARV work, nah?
Loon
http://www.who.int/hiv/pub/arv/advice/en/index.html
Where can I sign on?
I did not see to who we can write to be included on the list. anyone know?
Why a joint statement is needed
Interesting article which provides some of the reasons for the Statement on ART as Prevention
Millions at risk if AIDS focus fades, says expert
By Kate Kelland, Health and Science Correspondent
LONDON (Reuters) - Global attention is turning away from the AIDS epidemic at just the wrong time and means a fresh wave of the disease could infect millions of people in high-risk countries, a leading expert said Friday.
Alan Whiteside, director of the health economics & HIV/AIDS research division (HEARD) at Kwazulu Natal University said many African countries, where the disease poses the biggest threat, were failing to implement long-term prevention measures and needed help to plan for the battle ahead.
The AIDS threat is still very real in places like Swaziland, Lesotho, Botswana, Namibia, Zimbabwe, Zambia and Malawi and South Africa, he said, and a sense that the international community is ticking it off as "dealt with" is highly risky.
"(Fighting) the AIDS epidemic had a huge amount of support for many years, but there seems to be a perception now that it has been dealt with and we can turn our attention to other issues.
"This is most emphatically not the case in a number of parts of the world. It is not appropriate to turn our backs on it," Whiteside told Reuters in a telephone interview from South Africa, where the disease kills an estimated 1,000 people a day.
Some 33.4 million people in the world have HIV, the sexually transmitted human immunodeficiency virus that causes AIDS. Since AIDS emerged in the early 1980s, almost 60 million people have been infected and 25 million have died of HIV-related causes.
Sub-Saharan Africa is by far the worst affected region, accounting for 67 percent of people infected with HIV and 91 percent of all new infections in children, according to United Nations data.
HEALTH WORKERS, EDUCATION PROGRAMMES
Whiteside said health ministries needed to use aid funds now to equip and train health workers and produce safe-sex education programs to combine the importance of AIDS with a better grasp of the long-term impact of the disease on their countries.
The United States and South Africa recently pledged renewed efforts in the fight against AIDS,. In December the international health funding agency UNITAID approved plans for a drug "patent pool" to help make newer HIV and AIDS medicines available at lower prices to poorer countries.
But Whiteside said a growing sense that AIDS is no longer an emergency was bound to feed politicians' desire to be seen to be taking on new threats.
Climate change and the environment are the big issues now, and politicians may abandon the battle against AIDS, he said.
"At the moment, millions of Africans ore on HIV/AIDS treatment courtesy of the Americans, the Global Fund and other donors. Those treatments have to be for life, so if we see a redeployment of funding, people are simply going to die."
Whiteside pointed to "hyper-endemic" African countries like Malawi and Swaziland, where AIDS is so widespread that half of all women aged 25 to 29 have HIV or AIDS.
Prevention programs are crucial in such countries, he said, but are often patchy and suffer from governments' lack of leadership and cross-department, long-term vision.
Though clearly a personal and community disease, AIDS also threatens civil institutions like the health, agriculture and education sectors, which are needed to cut poverty, spur economic growth and raise living standards.
"We don't seem to have got our head around prevention in the hyper-endemic countries," he said. "We've still got new cases occurring -- and that's ridiculous, it's stupid, especially when you look ahead and see what that means in terms of the numbers of people that will need treatment. If we don't put our effort into prevention, we're likely to see more waves."
http://uk.reuters.com/article/idUKTRE61431P20100205?sp=true
I'd sign too
This statement is a small but important step forward on the issue of treatment versus prevention. I'd sign if I was an NGO. This paragraph is very true: "Developing and sustaining successful treatment programs requires working respectfully with and strengthening the capacity of civil society organizations that are at the front line of treatment literacy, adherence counseling, social support, and other work with persons and communities affected by HIV. Planning for and allocating resources to support civil society organizations should be central to any study of ART as prevention."