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Emerging Issues in Today’s HIV Response: Debate 6—Treatment as Prevention

On Thursday, November 10, 2011, the World Bank and the U.S. Agency for International Development (USAID) presented the sixth in a series of debates on emerging issues in the response to HIV. In an era when development aid is under pressure and the dynamics of the pandemic are constantly changing, it is imperative that governments, civil society organizations, and other partners have the best evidence and knowledge to maximize the effectiveness of development dollars and achieve results. The debate series was designed to advance discussion and begin to build consensus about contentious issues within the HIV community. The World Bank’s global video conferencing and web-based technologies allowed country teams in Africa and other partners from across the globe to participate in real time in the debate. Over 800 people registered to attend the debate either in person or remotely.

Debate 6 discussed the proposition, “Countries should spend a majority of what is likely to be a flat or even declining HIV prevention budget on ‘treatment as prevention.’” The topic reflects critical questions arising from observational studies and a recent prospective clinical trial demonstrating the effectiveness of antiretroviral therapy (ART) for HIV prevention. Much of the debate centered on the dramatic findings of the recent HIV Prevention Trials Network (HPTN) 052 study of 1,763 HIV-serodiscordant couples in nine countries in Africa, Asia, and Latin America. The HPTN 052 study showed that early treatment—started at a CD4 count between 350 and 550 cells/mm3—reduced the risk of HIV transmission to an uninfected partner by at least 96 percent. This suggests that starting ART earlier than many treatment guidelines currently recommend could have significant impact on the spread of HIV.