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May 27, 2010

Contact: Matthew Kavanagh, +1 202.486.2488, matthew@healthgap.org

Treating AIDS is Preventing AIDS:

Study Shows Striking 92% Reduction in HIV Transmission through AIDS Treatment,

Further Challenges Obama Administration Policy of Virtually Flat-lining AIDS and Leaving HIV-positive People Waiting in Line to Die

Today a peer-reviewed study in The Lancet showed that placing people living with HIV on antiretroviral treatment created a 12-fold reduction in transmission to their HIV-negative partner. This 92% decrease in the likelihood of transmission confirms the importance of scaling up widespread testing and reaching universal access (at least 80% coverage) to AIDS treatment. This finding suggests that the Obama Administration strategy of virtually flat-funding AIDS and slowing or halting scale up of access to AIDS treatment will undermine the world’s ability to eventually defeat HIV.

HIV is transmitted from people who already are infected. Therefore, reducing the risk of transmission from people already infected – so-called positive prevention - is critically important to reducing the rising tide of infection, nearly 2.5 million new cases a year.

Some in the White House, like health advisor Zeke Emanuel, claim that treating AIDS has low priority because five people become infected for every person newly put on treatment. They claim that global health resources are better spent on cheaper interventions like childhood vaccines and that AIDS funding should be diverted from treatment to prevention.

A new peer-reviewed study in the Lancet directly challenges this backward thinking. The study, conducted over 24 months by Deborah Donnell and colleagues from the Partners in Prevention HSV/HIV Transmission Study Team, concluded that "Provision of ART to HIV-1 infected patients could be an effective strategy to achieve population-level reductions in HIV-1 transmission."

“HIV+ people in Africa have the same right of access to life-saving antiretroviral therapy as rich people in the US,” said Kaytee Riek of Health GAP, a US-based AIDS activist organization. “But the benefits of treatment are not just to the individual – they extend to the patient’s sex partners and to the larger community. A robust program that guarantees universal access to treatment is now proven to be among the most efficacious HIV prevention strategies available to the world and, paired with other strategies, shows we can defeat HIV.”

Researchers were gratified to find that condom use actually increased slightly by patients who were counseled to engage in safer sex as part of the research protocol. Accordingly, continued efforts to encourage proper and consistent use of condoms, which is also 90% effective in reducing the risk of transmission, would greatly amplify transmission reduction. Additional proven prevention efforts must be scaled up with funding shifted there from ineffective programs.

PEPFAR’s current strategy is to prioritize treatment for patients in late-stage disease, with CD4 cell counts below 200—and often below 50—instead of at the new WHO recommended 350 CD4 cell count level. There are growing reports of PEPFAR implementers being told to keep patients on wait lists until another patient on treatment dies or is lost to care. According to the researchers’ findings, this is exactly the wrong strategy because viral loads go higher as cell counts fall and because most infections they observed were from subjects with low CD4 cell counts.

“The Obama administration has stated its commitment to science and evidence,” said Matthew Kavanagh of Health GAP. “The new evidence shows the moral and scientific bankruptcy of US policy to essentially flat-line funding for HIV/AIDS, to cap treatment slots, and to delay treatment until patients are at death’s door with skyrocketing viral loads. “

Health GAP and other AIDS activists urge an immediate reappraisal of US treatment and prevention policy to reassess not just the complementary but the essentiality of treatment to an effective prevention policy.

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