HIV, confidentiality, and duty to protect: Considerations for psychotherapists in the age of treatment as prevention.

Since the pharmaceutical turn, using HIV treatment to prevent transmission is increasingly common. Treatment as Prevention®, or TasP, has relied on HIV treatment to prevent HIV transmission, targeting people living with HIV. However, TasP is predicated on troublesome heterosexist, classist, and racist medical practices borrowed from various times and spaces that enact biopolitical and necropolitical relations. This paper discusses the debate surrounding the first clinical trial that used HIV treatment to prevent transmission from woman-to-foetus. The 1994 landmark AIDS Clinical Trials Group 076 study laid the groundwork for using HIV treatment to prevent HIV transmission, the essential precursor to TasP. By examining the concerns of HIV positive women of colour and other AIDS activists, we are able to understand the ethical dilemmas and practical consequences that still haunt today's game-changing uses of HIV treatment for prevention and to see how biopolitics and necropolitics persist in TasP.

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Treatment as prevention: a replication study on early antiretroviral therapy initiation and HIV-1 transmission

10.23846/rps0024 ◽

2020 ◽

Author(s):

Eric W Djimeu ◽

◽

Eleanor G Dickens ◽

Keyword(s):

Antiretroviral Therapy ◽

Replication Study ◽

Treatment As Prevention ◽

Therapy Initiation ◽

Hiv 1

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Refugees and Other Necessitous Migrants

10.1093/oso/9780190909222.003.0008 ◽

2018 ◽

Author(s):

Sarah Song

Keyword(s):

Immigration Policy ◽

Duty To Protect ◽

Moral Constraint

Chapter 7 considers the substance of immigration policy. It argues that the duty to protect refugees and other forcibly displaced migrants is a moral constraint on the state’s right to control immigration. The chapter examines the grounds of the obligation toward refugees, who should be regarded as a refugee, what the duty to assist refugees entails, how the duty should be shared among states, and what the limits on the duty to refugees might be. It concludes by considering some implications for contemporary policy toward refugees.

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‘Too old to test?’: A life course approach to HIV-related risk and self-testing among midlife-older adults in Malawi

BMC Public Health ◽

10.1186/s12889-021-10573-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Cheryl Johnson ◽

Moses Kumwenda ◽

Jamilah Meghji ◽

Augustine T. Choko ◽

Mackwellings Phiri ◽

...

Keyword(s):

Older Adults ◽

Life Course ◽

Hiv Testing ◽

Sexual Risk ◽

Age Groups ◽

Sub Saharan Africa ◽

Treatment As Prevention ◽

Sexual Risk Taking ◽

Rural And Urban ◽

Self Testing

Abstract Background Despite the aging HIV epidemic, increasing age can be associated with hesitancy to test. Addressing this gap is a critical policy concern and highlights the urgent need to identify the underlying factors, to improve knowledge of HIV-related risks as well as uptake of HIV testing and prevention services, in midlife-older adults. Methods We conducted five focus group discussions and 12 in-depth interviews between April 2013 and November 2016 among rural and urban Malawian midlife-older (≥30 years) men and women. Using a life-course theoretical framework we explored how age is enacted socially and its implications on HIV testing and sexual risk behaviours. We also explore the potential for HIV self-testing (HIVST) to be part of a broader strategy for engaging midlife-older adults in HIV testing, prevention and care. Thematic analysis was used to identify recurrent themes and variations. Results Midlife-older adults (30–74 years of age) associated their age with respectability and identified HIV as “a disease of youth” that would not affect them, with age protecting them against infidelity and sexual risk-taking. HIV testing was felt to be stigmatizing, challenging age norms, threatening social status, and implying “lack of wisdom”. These norms drove self-testing preferences at home or other locations deemed age and gender appropriate. Awareness of the potential for long-standing undiagnosed HIV to be carried forward from past relationships was minimal, as was understanding of treatment-as-prevention. These norms led to HIV testing being perceived as a threat to status by older adults, contributing to low levels of recent HIV testing compared to younger adults. Conclusions Characteristics associated with age-gender norms and social position encourage self-testing but drive poor HIV-risk perception and unacceptability of conventional HIV testing in midlife-older adults. There is an urgent need to provide targeted messages and services more appropriate to midlife-older adults in sub-Saharan Africa. HIVST which has often been highlighted as a tool for reaching young people, may be a valuable tool for engaging midlife-older age groups who may not otherwise test.

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From “Secret” to “Sensitive Issue”: Shifting Ideas About HIV Disclosure Among Middle-Aged and Older Rural South Africans in the Era of Antiretroviral Treatment

Journal of Aging and Health ◽

10.1177/08982643211020202 ◽

2021 ◽

pp. 089826432110202

Author(s):

Enid Schatz ◽

Ifeolu David ◽

Nicole Angotti ◽

F. Xavier Gómez-Olivé ◽

Sanyu A. Mojola

Keyword(s):

Older Persons ◽

Antiretroviral Treatment ◽

Hiv Disclosure ◽

Death Sentence ◽

Treatment As Prevention ◽

Negative Consequences ◽

Middle Aged ◽

Group Discussions ◽

Rural South ◽

South Africans

Objective As HIV shifts from “death sentence” to “chronic condition,” disclosure of HIV status to intimate partners and family is a significant component of both prevention and treatment adherence. While disclosure is closely considered in many studies, few examine middle-aged and older persons’ (age 40+) perspectives or practices. We trace older rural South Africans’ views on HIV disclosure to their partners and family members in a high prevalence community over a period of extensive antiretroviral treatment (ART) rollout. Methods Community focus group discussions (FGD) conducted in 2013 and 2018 show shifts in older persons’ thinking about HIV disclosure. Findings Our FGD participants saw fewer negative consequences of disclosure in 2018 than in 2013, and highlighted positive outcomes including building trust (partners) as well as greater support for medication collection and adherence (family). Discussion Particularly as the epidemic ages in South Africa and globally, tracing changes in older persons’ views on disclosure is an important step in developing messaging that could enhance treatment as prevention and ART adherence.

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Changing Knowledge and Attitudes Towards HIV Treatment-as-Prevention and “Undetectable = Untransmittable”: A Systematic Review

AIDS and Behavior ◽

10.1007/s10461-021-03296-8 ◽

2021 ◽

Author(s):

Jacob Bor ◽

Charlie Fischer ◽

Mirva Modi ◽

Bruce Richman ◽

Cameron Kinker ◽

...

Keyword(s):

Systematic Review ◽

Viral Suppression ◽

Hiv Treatment ◽

Treatment As Prevention ◽

Global Literature ◽

Knowledge And Attitudes ◽

Positive Attitudes ◽

The World ◽

Hiv Treatment As Prevention ◽

Changing Knowledge

AbstractPeople on HIV treatment with undetectable virus cannot transmit HIV sexually (Undetectable = Untransmittable, U = U). However, the science of treatment-as-prevention (TasP) may not be widely understood by people with and without HIV who could benefit from this information. We systematically reviewed the global literature on knowledge and attitudes related to TasP and interventions providing TasP or U = U information. We included studies of providers, patients, and communities from all regions of the world, published 2008–2020. We screened 885 papers and abstracts and identified 72 for inclusion. Studies in high-income settings reported high awareness of TasP but gaps in knowledge about the likelihood of transmission with undetectable HIV. Greater knowledge was associated with more positive attitudes towards TasP. Extant literature shows low awareness of TasP in Africa where 2 in 3 people with HIV live. The emerging evidence on interventions delivering information on TasP suggests beneficial impacts on knowledge, stigma, HIV testing, and viral suppression.Review was pre-registered at PROSPERO: CRD42020153725

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Considering treatment-as-prevention scale-up for Australian prisons: a qualitative sub-study of expert stakeholders from the Australian ‘surveillance and treatment of prisoners with hepatitis C’ project (SToP-C)

Harm Reduction Journal ◽

10.1186/s12954-021-00494-4 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Jake Rance ◽

◽

Lise Lafferty ◽

Carla Treloar

Keyword(s):

Hepatitis C ◽

Primary Prevention ◽

Critical Role ◽

Scale Up ◽

Treatment As Prevention ◽

Structured Interviews ◽

Hcv Treatment ◽

Public Health Response ◽

Direct Acting ◽

Levels Of Support

Abstract Background With direct-acting antivirals dramatically reshaping the public health response to the hepatitis C virus (HCV), prisons are set to play a critical role in elimination efforts. Despite the theoretical demonstration of HCV treatment-as-prevention in prison in mathematical modeling, limited empirical data exist. The Australian ‘Surveillance and Treatment of Prisoners with Hepatitis C’ project (SToP-C) is the world’s first trial of HCV treatment-as-prevention in prison. Drawing on interviews with HCV expert stakeholders, this paper explores the factors respondents identified as crucial to the success of future scale-up. Accounting for such perspectives matters because of the influence expert discourse has in shaping implementation. Methods Semi-structured interviews were conducted with nineteen HCV experts working across key policy, advocacy, research and clinical dimensions of the Australian HCV response. Data were coded using qualitative data management software (NVivo 11). Analysis proceeded via a hybrid deductive and inductive approach. Results Notwithstanding concerns regarding the lack of primary prevention in Australian prisons, stakeholders reported broad levels of support for the intervention and for the future scale-up of HCV treatment. A number of considerations, both external and internal to the prison system, were identified as key. The principal external factor was an enabling political-cum-policy environment; internal factors included: obtaining support from prisons’ executive and custodial staff; promoting health within a security-first institutional culture; allocating time for treatment within prisoners’ tightly regulated schedules; ensuring institutional stability during treatment given the routine movement of prisoners between prisons; prioritizing the availability of retreatment given the paucity of primary prevention; and securing sufficient clinical space for treatment. Conclusion The challenges to implementation are considerable, ranging from macrolevel concerns to in-prison logistical matters. Nonetheless, we argue that prisons remain an obvious setting for treatment scale-up, not only for prevention and potential elimination benefit, but for the treatment opportunities they afford a socially disadvantaged and underserved population. While noting widespread concerns among respondents regarding the paucity of primary prevention in Australian prisons, results indicate broad levels of support among expert stakeholders for HCV treatment scale-up in prison.

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