HIV in the international context: Two steps forward, one step back?

Ian Hodgson
Independent Consultant, HIV Education and Research

Welcome to this edition of HIV Nursing. One of the privileges of writing an end-of-year editorial is the opportunity for retrospection. Each year it’s important to acknowledge advances against HIV, and major events in 2013 such as the International Congress on AIDS in Asia and the Pacific (ICAAP), held in Bangkok during November 2013, have reported significant improvements in access to HIV treatment in the region, and a reduction overall in the number of new infections. In addition, as another example, I’ve just returned from some participatory evaluation work in Zambia. Here, projects supporting HIV prevention for sex workers in a border town close to Malawi are having real impact at the community level. This is through effective joined-up thinking and planning involving both civil society and government agencies [1].
This year has also seen growing emphasis on treatment as prevention (TasP). The idea of providing treatment as prevention emerged following a landmark study [2], which included 1763 discordant couples in nine countries, suggesting that early initiation of antiretroviral therapy (ART) reduced HIV transmission and improved the overall health of affected individuals. TasP clearly has implications for both personal and public health, but ethical questions remain: Will there be pressure on a PLHIV who doesn’t want to use TasP? What about the requirements of those with symptomatic HIV who still can’t get treatment? And perhaps, most significantly, the nemesis of public health – the danger of complacency when there is a perceived reduction in HIV risk. Read more…