15 Feb 2017

Follow Up on previous article: On Fear, Infectiousness, Undetectability

Last week, GNP+ published a statement offering an alternative perspective on the messaging of campaigns on the uninfectiousness of people living with HIV who achieve viral suppression, including the U=U (Undetectable = Untransmittable) campaign. Following reactions from supporters of the campaign, GNP+ releases the following statement clarifying our position on this important issue.

GNP+ acknowledges that certain arguments made in our On Fear, Infectiousness, Undetectability statement were unduly critical of the U=U campaign. We take these criticisms seriously and apologize for the way in which some of our points were insensitively framed.

Our intention in publishing the statement was not to undermine the mission of the U=U campaign. We recognize the significant and important empowerment aspects for people living with HIV in knowing the advancements in evidence over the last few years in HIV treatment as prevention; evidence that should be communicated and understood more broadly. In some contexts, the U=U campaign brings much needed attention to issues of stigma and discrimination through the messaging on the efficacy of ARVs to eliminate the risk of transmission.

Our intention in publishing our statement was however to promote a broader discussion around three main areas.

One: the need for balancing messages on treatment as prevention with messages that reaffirm the prioritisation of treatment as treatment, in particular in contexts where treatment access is limited and/or unequally accessed by all people living with HIV, in all their diversity.

Two: treatment as prevention messages as a stand-alone bring uncomfortable reminders of ‘prevention with positives’ programmes that put the responsibility of prevention solely on people living with HIV.

Three:  that while treatment as prevention benefits can be celebrated, in much of the world, and in many contexts, treatment access remains far out of reach for more than half of people living with HIV. Further, where limited treatment is available, there exist inequities in access among the diversity of people living with HIV. Moreover, viral load diagnostics are scarce and, for many, viral load tests are unaffordable.

GNP+ believes the response to HIV needs to urgently address the current political and economic limitations that make it all but impossible for many PLHIV in many contexts to get on treatment, stay on treatment, demand viral load testing and achieve undetectable status.

While we were wrong to single out the U=U campaign as the example of treatment as prevention messaging, we stand by our concern that the attainment of undetectability remains, for many, a problematic manner by which to describe PLHIV, regardless of whether or not they are on treatment.

With less than 3 years left until 2020, progress towards the 90-90-90 targets (90% of people living with HIV knowing their HIV status, 90% of people who know their HIV-positive status accessing treatment and 90% of people on treatment having suppressed viral loads) remain seriously off track in many parts of the world. Approximately 54% of the roughly 36.7 million people worldwide living with HIV who are in need of ARVs but lack treatment access. For PLHIV in the developed countries who currently may have reliable and uninterrupted access to HIV treatment and care – treatment as prevention is to be celebrated, is empowering, and can fight stigma and discrimination and challenge irrational and ineffective criminalisation laws. For millions of PLHIV in countries with low treatment access and weak health systems, however, treatment as prevention messages must be developed carefully in collaboration with local networks of people living with HIV

GNP+’s statement, while controversial, has revived important and timely discussions about the need for increased advocacy for treatment for treatment for those who need it; as well as for the need to amplify the messages that we now have the science and evidence to bring down the wall of dichotomy between treatment and prevention. These arguments are complementary, not contradictory.

We must remain ever vigilant to preserve safe space within our diverse community for ongoing dialogue, debate, disagreement and alternative perspectives. We recognise and support the empowering message that the U=U campaign champions for PLHIV whose access to treatment is assured.

GNP+ remains committed towards advancing the use of inclusive language that prioritises the health, safety and wellbeing of all PLHIV, regardless of their treatment access and/or detectability status within a framework of positive health, dignity and prevention. In this line, we would like to invite all relevant stakeholders into constructive dialogues to further discuss these issues.

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