As the World Health Organisation (WHO) gathers to discuss the 2015 guidelines for antiretroviral medicines, the Global Network of People Living with HIV (GNP+) hails the results of the START (Strategic Timing of AntiRetroviral Treatment) trial, which has indicated that a new epoch for approaches to HIV treatment has dawned.
“The results show unequivocally that universal access to treatment for all people living with HIV at diagnosis who want it, regardless of their CD4 count, is a right to health. There is no ethical reason now not to make treatment accessible to all,” said Suzette Moses-Burton, Executive Director of GNP+.
Just as existing treatment targets are based around the seminal results of the HPTN 052 study, which led to a public health Treatment as Prevention approach, the START trial highlights the health benefits of early treatment for all people living with HIV. GNP+ calls on global health officials to heed the message of the trial as the WHO 2015 antiretroviral guidelines development group convenes and debates what the new guidelines should include.
“As target-setting debates around the post-2015 Sustainable Development Goals continue, the community of people living with HIV shouldn’t collude in austerity arguments of resource allocation, and public health arguments about prioritising some people over others. To make the end of AIDS a reality we need treatment to be accessible and affordable for all those who need and choose to start treatment,” said Suzette Moses-Burton.
However, the availability of treatment comes with some caveats. It is crucial that treatment is of the best quality, accessible and available, that some of the root causes of interrupted treatment such as drug stock outs are tackled, and that freedom to choose when to take treatment remains a core value. Finally, we need to dispel existing fears that treatment is for those who are already sick by increasing the treatment literacy amongst communities. People living with HIV should understand that high quality treatment is less toxic than HIV, and that it is never too early to start treatment from a health point of view.
Edwin J. Bernard, Co-ordinator of the HIV Justice Network, points out that treatment for all will only be effective in the context of tackling a range of other issues for people living with HIV: “If we don’t also take action on reducing stigma for people living with HIV and decriminalisation of populations living with HIV, particularly men who have sex with men, sex workers and people who use drugs, then the full rights of people living with HIV, as articulated in the Positive Health, Dignity and Prevention Framework, will never be realized.”