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Inter Press Service - December 10, 2008
Nastassja Hoffet
According to the medical journal The Lancet, which published the new findings based on a mathematical model developed by a group of HIV specialists at the WHO, "Universal and annual voluntary testing followed by immediate antiretroviral therapy treatment can reduce new HIV cases by 95 percent within 10 years."
However, experts also stress that calls for a massive scale-up of testing and treatment must be accompanied by caution and a fundamental respect for human rights.
"This article can be perceived as rather an exciting way to look at access to universal treatment and testing," Patricia Daoust, director of the Physicians for Human Rights' Health Action AIDS Campaign, told IPS. "There are many challenges in regard to implementation and these challenges need to be addressed."
"We have to look carefully at how people are being tested, by whom, if they are being properly counseled, if it is truly voluntary," Daoust said.
Kevin Moody of the Global Network of People living with HIV/AIDS (GNP+) agreed. "Concerning annual voluntary testing, it's difficult to imagine you can get 100 percent testing [while] making sure it is confidential and voluntary," he said.
WHO experts acknowledge that the model represents a starting point for a strategy that must be fleshed out by donors, governments, public health experts and civil society.
"We are looking for solutions. We look for more debate to know what it is possible from the human rights point of view and the political point of view," Andrey Pirogov, executive director of the WHO Office at the United Nations, told IPS.
"No one is pushing for mandatory testing and treatment," clarified Bradley Hersh, coordinator of the Operational and Technical Support Team of the HIV/AIDS Department at WHO headquarters in Geneva. "Testing must be consentual, confidential, and counseled."
Physicians, researchers and community health workers have long understood the importance of testing and treatment to curb the epidemic, but often face a lack of resources as well as social stigmas attached to the disease.
"This article discusses an important advance in science and encourages human rights activists to think anew about expanding approaches to testing, counseling and treatment," Mandeep Dhaliwal of the U.N. Development Programme (UNDP) HIV/AIDS unit told IPS.
"To dramatically expand treatment access as soon as possible after infection could really be important in effectively stemming the spread of HIV," she added.
Moody of GNP+ noted that all the tools to fight the epidemic already exist. "People are dying for no reason," he said. "We have universal access for 2010 on the table, according to the WHO guidelines, but we are not going to get close to that. If political will is there, it would possible to realise it."
"There is still a lot of stigma and discrimination against people HIV infected, so it is important to work with countries to make a safe environment for people to get tested," he added.
Universal testing and immediate antiretroviral treatment get tricky when one is talking about literally billions of people, in a wide variety of cultural and economic settings.
"Currently, the upscale of prevention and treatment programmes is undermined by gender inequality, violence against women, against sexual minorities, mandatory testing, lack of confidentiality, stigma and discrimination, and criminalisation of sex workers and drug users," noted Dhaliwal.
"The next evolution of the thinking along this article will be looking at costing, which includes protection for human rights and reducing stigma and discrimination," she said.
From a medical point of view, the proposal to give people living with HIV immediate treatment also raises questions about potential side effects if taken too early after testing. Antiretroviral treatment is a long-life process and can entail adverse health effects.
"First line anti-retrovirals (ARVs) have become less toxic, but second and third line treatments which would be required when drug resistance occurs are much more toxic and much more expensive," Seth Berkley, president of the International AIDS Vaccine Initiative, told IPS.
NGO activists in the field of HIV/AIDS care are demanding more research into the long-term effects of immediate treatment after testing positive.
"It is extremely important for the patient to be in the centre of the care, to be aware of the risk and benefit when he decides when and what kind of treatment to take," said Moody.
An appropriate environment where "people are properly counseled, educated, have access to comprehensive information and protected from stigma and discrimination" based on human rights principles could help realise universal and voluntary testing and assuage people's reluctance to take the cure, he stressed.
According to the WHO figures, 80 percent of people living with HIV are not tested. Today, 33 million people are living with HIV, 22 million in Sub-Saharan Africa. Among them, only 2.9 million people received ARV treatment in 2007, while 9.7 million needed it.
The authors of the article, Reuben M Granich, Charles F Gilks, Christopher Dye, Kevin DeCock and Brian G. Williams, estimate that by 2032, "The yearly cost of the present strategy and the theoretical strategy would both be U.S. 1.7 billion dollars".
The Global Fund to fight AIDS, Tuberculosis and Malaria has committed 5.86 billion dollars since 2005. Funding reached 10 billion dollars in 2007, including the 7 to 10 billion targeted in the U.N. Declaration of Commitment on HIV/AIDS in 2001.
"So in theory, this new model would work. But given the impracticality of this intervention, it is unlikely to work in a real life situation," Berkley added.
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+ Caribbean: Despite Successes, Too Many Dying of AIDS (http://www.aegis.org/news/ips/2008/IP081203.html)
+ Africa: Breaking the Cycle of HIV Transmission (http://www.aegis.org/news/ips/2008/IP081201.html)
+ More IPS Coverage of HIV/AIDS (http://www.ipsnews.net/hivaids.asp)
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