scholarly journals HIV Treatment as Prevention: Contradictory Perspectives from Dynamic Mathematical Models

2014 ◽  
Vol 2014 ◽  
pp. 1-9
Author(s):  
Jing Wu ◽  
Jessie L. Norris ◽  
Yujiang Jia ◽  
Ning Wang
Keyword(s):  
Mathematical Models ◽  
Hiv Transmission ◽  
Dynamic Models ◽  
Hiv Infections ◽  
Hiv Treatment ◽  
Treatment As Prevention ◽  
Poor Countries ◽  
Input Variables ◽  
Hiv Treatment As Prevention ◽  
Preventive Effects

The preventative effects of antiretroviral therapy for people with HIV have been debated since they were first raised. Models commenced studying the preventive effects of treatment in the 1990s, prior to initial public reports. However, the outcomes of the preventive effects of antiretroviral use were not consistent. Some outcomes of dynamic models were based on unfeasible assumptions, such as no consideration of drug resistance, behavior disinhibition, or economic inputs in poor countries, and unrealistic input variables, for example, overstated initiation time, adherence, coverage, and efficacy of treatment. This paper reviewed dynamic mathematical models to ascertain the complex effects of ART on HIV transmission. This review discusses more conservative inputs and outcomes relative to antiretroviral use in HIV infections in dynamic mathematical models. ART alone cannot eliminate HIV transmission.

scholarly journals HIV incidence among gay men and other men who have sex with men in 2020: where is the epidemic heading?

Sexual Health ◽  
2017 ◽  
Vol 14 (1) ◽  
pp. 5 ◽  
Author(s):  
Shauna Stahlman ◽  
Carrie Lyons ◽  
Patrick S. Sullivan ◽  
Kenneth H. Mayer ◽  
Sean Hosein ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Hiv Infections ◽  
Retention In Care ◽  
Hiv Treatment ◽  
Treatment As Prevention ◽  
Structural Level ◽  
Hiv Incidence ◽  
Hiv Risks ◽  
Sex With Men ◽  
Hiv Acquisition

The goal to effectively prevent new HIV infections among gay, bisexual, and other men who have sex with men (MSM) is more challenging now than ever before. Despite declines in the late 1990s and early 2000s, HIV incidence among MSM is now increasing in many low- and high-income settings including the US, with young, adolescent, and racial/ethnic minority MSM being among those at highest risk. Potentiating HIV risks across all settings are individual-, network-, and structural-level factors such as stigma and lack of access to pre-exposure prophylaxis (PrEP) and antiretroviral treatment as prevention. To make a sustained impact on the epidemic, a concerted effort must integrate all evidence-based interventions that will most proximally decrease HIV acquisition and transmission risks, together with structural interventions that will support improved coverage and retention in care. Universal HIV treatment, increased access to HIV testing, and daily oral PrEP have emerged as integral to the prevention of HIV transmission, and such efforts should be immediately expanded for MSM and other populations disproportionately affected by HIV. Respect for human rights and efforts to combat stigma and improve access to prevention services are needed to change the trajectory of the HIV pandemic among MSM.

A New Era of HIV Risk: It's Not What You Know, It's Who You Know (and How Infectious)

2019 ◽  
Vol 70 (1) ◽  
pp. 673-701 ◽  
Author(s):  
Andrew C. Cortopassi ◽  
Redd Driver ◽  
Lisa A. Eaton ◽  
Seth C. Kalichman
Keyword(s):  
Hiv Prevention ◽  
Hiv Risk ◽  
Hiv Transmission ◽  
Belief Systems ◽  
Hiv Treatment ◽  
Sexual Relationships ◽  
Treatment As Prevention ◽  
New Era ◽  
Sexually Transmitted ◽  
Hiv Treatment As Prevention

HIV is transmitted in social and sexual relationships, and HIV transmission risks, as well as protective actions, are evolving as HIV epidemics unfold. The current focus of HIV prevention is centered on antiretroviral medications used to reduce HIV infectiousness in persons already infected with HIV [treatment as prevention (TasP)]. The same medications used to treat infected persons can also be used by uninfected persons as pre-exposure prophylaxis (PrEP) to reduce the infectivity of HIV. Both PrEP and TasP are effective when adherence is high and individuals do not have co-occurring sexually transmitted infections. HIV prevention is most effective and efficient when delivered within sexual networks with high HIV prevalence. Specific network characteristics are recognized as important facilitators of HIV transmission; these characteristics include the degree of similarity among network members (homophily), gender role norms, and belief systems. Since 2011, HIV risk has been redefined based on infectiousness and infectivity, ushering in a new era of HIV prevention with the potential to end HIV epidemics.

HIV treatment as prevention: not an argument for continuing criminalisation of HIV transmission

2013 ◽  
Vol 9 (4) ◽  
pp. 520-534 ◽  
Author(s):  
John G. Francis ◽  
Leslie P. Francis
Keyword(s):  
Hiv Prevention ◽  
Hiv Transmission ◽  
Punctuated Equilibrium ◽  
Hiv Treatment ◽  
Treatment As Prevention ◽  
Risky Behaviour ◽  
Treatment And Prevention ◽  
Prevention And Treatment ◽  
New Treatment ◽  
Hiv Treatment As Prevention

AbstractHIV prevention and treatment are undergoing impressive technological and practice changes. In-home rapid testing, prophylaxis before risky sex, and treatment as prevention give cause for remarkable optimism and suggest the possibility of an AIDS-free generation. These changes in HIV prevention and treatment might affect HIV policy in several different directions. One direction would be further entrenchment of the currently prevailing punitive approach. A different direction would be a shift away from use of the criminal law as a method for discouraging risky behaviour and towards a strategy aimed to encourage the use of the new treatment and prevention possibilities. When such abrupt technological changes are accompanied by sharp changes in regulatory regimes, they are identified in the public policy literature as a ‘punctuated equilibrium’. A shift away from criminalisation in HIV policy, if sufficiently widespread and transformative, could reach the level of a punctuated equilibrium. This paper presents a critical assessment of the implications of the changes in available forms of treatment and prevention for the continued appeal of criminalisation as an approach to HIV policy. We conclude that criminalisation is less justifiable in the light of what might be circumstances ripe for a punctuated equilibrium.

The Bio/Necropolitics of ACTG 076: Lessons from Pregnant Women of Colour Living with HIV for Treatment for Prevention in the Twenty-first Century

Somatechnics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 233-253
Author(s):  
Eli Manning
Keyword(s):  
Hiv Transmission ◽  
Ethical Dilemmas ◽  
Hiv Treatment ◽  
First Century ◽  
Hiv Positive ◽  
Treatment As Prevention ◽  
People Living With Hiv ◽  
Hiv Positive Women ◽  
Aids Clinical Trials ◽  
Living With Hiv

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.

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

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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