23 Nov 2010
Results of iPrEx study remind us why universal access to HIV treatment and prevention is crucial
The Global Network of People living with HIV recognises the contribution of researchers and trial participants; emphasises the role of people living with HIV in ARV-based prevention; and calls on new prevention tools to be placed within the broader universal access movement.
Results of the Pre-exposure Prophylaxis Initiative (iPrEx) study indicate that a daily oral dose of two antiretrovirals (ARVs) in one pill reduced the number of new HIV infections among sexually active men and transgender women who have sex with men by 44%. The study, which was conducted among 2,499 HIV-negative individuals between the ages of 18 and 67 in six countries – Brazil, Ecuador, Peru, South Africa, Thailand and the United States – found that for individuals with 90% or greater daily adherence, there was 73% reduced risk.
This significant HIV prevention development highlights the importance of further research to respond to the HIV prevention needs of key populations that are disproportionately affected by HIV.
GNP+ recognises the contribution of the men and transgender women who took part in the study. Of the almost 5000 individuals who were screened for the study, 410 were found to be living with HIV and, thus, ineligible for enrolment. A further 110 individuals seroconverted during the course of the trial. These individuals with HIV-positive test results remind us of the impact of HIV prevention studies on the lives of people living with HIV. GNP+ calls on governments and those involved in funding and implementing these studies to ensure that all those who are found to be HIV-positive during screening or during HIV prevention trials are provided with the necessary treatment, care and support.
The results of the iPrEx study illustrate why it is crucial to ensure universal access to both treatment and prevention. We must carefully consider the implications of providing ARVs to HIV-negative people as we continue to secure and provide treatment for people living with HIV. Despite unprecedented progress over the past decade towards universal access to antiretroviral therapy (ART), it is estimated that by the end of 2009 only 36% of the 14.6 million people in low- and middle-income countries who need treatment were receiving ART.[i] Recent reports from Africa[ii] and Eastern Europe[iii]  highlight that governments are beginning to cap the number of people living with HIV enrolled in treatment programmes and that drug stockouts are becoming increasingly more frequent.
Kevin Moody, International Coordinator and CEO of the Global Network of People living with HIV states: “As treatment and prevention come together, it is important to involve HIV-positive people in discussions about how PrEP can and should be made available in the future. People living with HIV have a critically important role to play in HIV prevention, both for the development of new HIV prevention tools and in advocating for improved access to existing prevention options”.
Jorge Beloqui of Grupo de Incentivo à Vida and ABIA – networks of people living with HIV in Brazil – adds: “As community members with a great deal of insight into the realities of living with HIV, and with professional as well as personal expertise, people living with HIV can provide guidance on a range of ethical and practical issues. People living with HIV can also provide guidance on how to mitigate the harm of HIV-related stigma, which may be a barrier to HIV testing, disclosure of HIV-positive status and the ability and willingness to follow-up linkages to prevention, treatment, care and support – all key issues for the delivery of PrEP”.
Advocacy for PrEP and other new HIV prevention tools should be placed within the broader context of universal access for treatment, prevention, care and support. Globally, less than one person in five at risk of acquiring HIV has access to basic HIV prevention services.[iv] In many settings around the world there remains inadequate access to male and female condoms, needle/syringe exchange, medical male circumcision, post-exposure prophylaxis (PEP), prevention of vertical transmission and voluntary counseling and testing.
Advocating for improved access to these proven prevention methods sets the stage for the effective introduction of new prevention tools. This requires further collaboration between prevention advocates and treatment activists as well as broader community engagement. This broad based collaboration is key to promoting a holistic, human rights-framed approach to HIV prevention, which enables people living with and affected by HIV to achieve Positive Health, Dignity and Prevention.[v]
The Global Network of People living with HIV (GNP+) is a global network for and by people living with HIV. GNP+ advocates to improve the quality of life of people living with HIV. The central theme for the work of GNP+ is Reclaiming Our Lives! GNP+ programmes are organised under four platforms of action: Empowerment; Positive Health, Dignity and Prevention; Human Rights; and Sexual and Reproductive Health and Rights.
Please contact GNP+ (Martin Stolk, Communications officer, by email email@example.com, or phone +31-20-423 4114)
 Numbers based on the November 2009 WHO ART Guidelines, which recommend commencing ART before CD4 counts fall below 350 cells/mm3. Prior guidance recommended treatment for people with advanced symptoms of HIV disease, or a CD4 count below 200 without symptoms. See www.who.int/hiv/pub/arv/advice/en/index.html
 The website www.pereboi.ru from the International Treatment Preparedness Coalition in Eastern Europe and Central Asia (ITPCru) reports stockouts in Ulyanovsk, Samara, Arkhangelsk, the Moscow Oblast, Vladimir, Kaliningrad, Saratov and other regions.
[i] WHO/UNAIDS/UNICEF. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. Geneva, 2010.
[ii] ITPC. Missing the Target 8 – Rationing Funds, Risking Lives: World Backtracks on HIV Treatment, April 2010.
[iii] Boseley S. Romania runs out of Aids drugs. The Guardian, April 23, 2010.
[iv] WHO. Universal access by 2010. WHO website, Accessed April 14, 2010.
[v] GNP+,UNAIDS. 2010. Policy Framework: Positive Health, Dignity and Prevention. Amsterdam, GNP+ (forthcoming).