Singh, J.A. AIDS (March 2013), Vol. 27 No. 6, pp. 863-865.
In this article, J.A. Singh discusses the ongoing debate surrounding the designation of antiretroviral (ARV) resources for HIV treatment versus HIV prevention. According to Singh, HIV treatment and prevention, utilizing pre-exposure prophylaxis (PrEP), should be implemented simultaneously, and also concurrently with an expanded HIV testing and counseling (HTC) program. Treatment and prevention should not be viewed as incompatible. It is unethical to deny ARV treatment for prevention because many people are at high risk of HIV, yet unable to protect themselves. Treatment as prevention, with its dual objectives of treatment and prevention is flawed in settings where HIV prevalence is high, multiple concurrent partnerships are common, and the implementation of HTC for couples is challenging. ARV allocation for HIV prevention is a human rights responsibility. Many countries have accepted the International Covenant on Economic, Social and Cultural Rights to provide “minimum core obligations.” Importantly, this covenant includes vulnerable populations with limited or no access to HIV services. Multisectoral stakeholders must identify vulnerable groups that are in urgent need of prioritized access. Policies will need to be adopted to ensure sustainable programmatic implementation of HIV treatment and PrEP. The author concluded that implementing the strategies concurrently, with scaled-up HTC access, may help achieve the "AIDS-free generation" goal of the Joint United Nations Program on HIV and AIDS.