What about the idea of HIV treatment as prevention for tackling the global AIDS epidemic?

What about the idea of HIV treatment as prevention for tackling the global AIDS epidemic?

In 2008 a group of Swiss scientists produced the first ever consensus statement which asserted that an HIV positive person who is taking effective antiretroviral therapy, has an undetectable viral load and is free from STDs, has a negligible risk of infecting others with the virus.⁶ Their conclusion was drawn from the results of studies which showed that if an effective treatment regimen is followed, one partner living with HIV will not pass on the virus to their HIV-negative partner. (For more information on this issue read AVERT's HIV transmission and antiretroviral therapy briefing sheet).

Since the Swiss statement, various studies have emerged that have investigated the relationship between viral load and HIV transmission. For example:

• Observational studies looking at the effect of HIV treatment at the community level have found that as the number of people taking more effective HIV treatment has risen, community viral load has decreased, resulting in a reduction of new HIV infections.^{7 8}
• A large, randomised, placebo-controlled trial involving 3381 heterosexual African couples found antiretroviral therapy use by the HIV infected partner was associated with a 92 percent reduction in risk of HIV-1 transmission to their fellow partner.⁹

Taking into account the ‘Swiss statement’ and these other studies, some advocates have argued that a way to reduce the global AIDS epidemic would be to test everyone in 'high risk' groups and areas of generalised epidemics, and then immediately treat all of those diagnosed positive, regardless of whether their immune system is damaged.¹⁰ This 'test and treat' strategy is due to be tested in a large scale trial in KwaZulu-Natal, one of South Africa's provinces most affected by HIV and AIDS. The Treatment as Prevention (TasP) trial is expected to start in 2011 and is hoped to last until 2015.¹¹