Volume 11 Number 3/4 March/April 2010

An important focus at CROI this year was the direct impact that current treatment is already likely to be having on reducing transmission.

The results are particularly important given that many treatment programmes in developing countries are under increasing pressure to limit enrollment of new patients, while 70% of people in immediate need of ARVs globally have yet to access them.

When treatment is pitched against prevention for funding, the phase ‘we can’t treat our way out of the epidemic’ is often used, and CROI provided new data challenges this misconception.

Another prominent statement is that ‘for every person put on treatment, there are two new infections’.

The CROI data challenges this too, though it has always been flawed logic to link these two unconnected figures.

The numbers accessing treatment are driven by the effectiveness of treatment programmes. Double the programme and the equation equalises. Scale treatment up four times and the impact is reversed: ‘for every two people on treatment only one person becomes infected’ etc.

When this connection is made it is insidious, because it implies that people on treatment are driving new infections. It is challenging and undermining our right to care. It seeks to connect two broadly different groups of people. New infections are predominantly driven by people who themselves are recently infected but currently unaware of their new HIV status, whereas people on treatment are likely to already have modified risks for onward transmission.

So, post-CROI, based on very conservations data from the PARTNERS and other studies, lets revise the link between treatment and prevention and say clearly that ‘every person on treatment prevents at least nine new infections’.

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