Estimates of 96% for the preventative efficacy of ART against HIV transmission, reported in 2011 by Myron & Cohen (M&C), appeared at last to place long-term containment of the epidemic in our hands. In the wake of this, UNAIDS: 90-90-90 proposed ambitious targets: 90% of those living with HIV to know their status; 90% of […]
Category: Preventative effect of ART
HIV prevention through HAART: a victim of its own success?
A recent study (Kalichman & Allen (K&A)) involving a series of four cross-sectional surveys (1996-2016) at a Gay Pride event in US Atlanta Georgia adds to the mounting body of evidence that substantial changes have occurred in community-held beliefs about the safety of certain sexual behaviours in the era of HIV treatment as prevention. It […]
First study of population-level preventative impact of Medical Male Circumcision and ART on HIV incidence in a country of sub-Saharan Africa
Clinical studies have demonstrated the potential effectiveness of ART (HPTN 052) and Voluntary Medical Male Circumcision (VMMC) (Gray & Kigozi/STIs) as preventative measures against HIV. This led WHO/UNAIDS to launch a Joint Strategic Action Framework (JSAF) setting a target in 14 priority sub-Saharan countries of 80% VMMC by 2016. What, then, are the potential gains of ART and VMMC interventions in […]
Viral suppression through ART prevents HIV transmission between long-term sero-different MSM and heterosexual partners regardless of condom use
The HPTN 052 study demonstrated the preventative benefit of ART, showing a dramatic 96% reduction in HIV transmission in HIV+ participants randomized to early ART initiation compared with the group that deferred treatment. This is very encouraging. But from the perspective of a gay person considering the risk of engaging in condomless sex with a […]
Inadequacy of ‘treatment as prevention’ strategy for combating HIV in young US MSM
The secret of containing the HIV epidemic is the successful engagement of key populations, we are told. In the case of the US that evidently includes young MSM (YMSM), amongst others. The scale of the task that confronts public health interventions aimed at prevention in this group is brought out in a recent study by Wilson & Hightow-Weidmann […]
Increased HIV infectivity in the acute phase of infection may be a less important factor in HIV transmission than we thought
Assessing, as far as we can, the preventative impact of ART on HIV transmission dynamics is evidently very important – both to inform judgments about ART initiation (Wayal & Hart (STI); Cohen (STI)), and also, at the policy level, to be able to evaluate the possible preventative gains of ART scale-up (Shafer & White (STI); […]
Can financial incentives help address the problem of HIV lost-to-follow-up in the US?
An article by Skarbinski & Mermin, discussed in my recent blog, Skarbinski & Mermin (STI/blogs), throws into sharp light the problem of the 45.2% of the HIV/AIDS infected population who are diagnosed but lost to follow-up. According to their estimate this group are responsible for 61.3% of transmissions. Various local attempts have been made to […]
Reported 86% effectiveness for MSM PrEP by PROUD study makes this intervention a viable option for UK health services
The Conference on Retroviruses and Opportunistic Infections has recently taken place. At that event the UK PROUD (PRe-exposure Option for reducing HIV in the UK: immediate or Deferred) study of pre-exposure prophylaxis (PrEP) for MSM reported its results, prior to publication in the coming months. The headline figure is an astonishing 86% for the reduction […]
Responding appropriately to differentials in HIV care outcomes – are local answers needed?
The recent discovery of the preventative potential of anti-retroviral therapy (ART) (STIs/blog/modelling ART impact) throws into sharp relief the challenge represented for the US by the very inadequate proportion of its 1.2 million HIV+ citizens (<30%) who are virally suppressed. Nunn & Mayer use new geographical mapping tools to bring home forcibly the epidemiological dimension […]
Are African HIV epidemics sustained by exogenous introduction of infection?
What is the relative importance of exogenous and endogenous transmission in sustaining HIV epidemics? In a study of HIV sub-type distribution in the Middle East, Mumtaz & Abu Raddad (STIs) stress the role of multiple exogenous introductions, as evidenced in the wide diversity of genetic sub-types present in most countries. At a more local level, […]