Understanding Concerns About Treatment-as-Prevention Among People with HIV who are not Using Antiretroviral Therapy
- 342 Downloads
The use of antiretroviral therapy to prevent HIV transmission is now advocated in many settings, yet little research has documented the views of people with HIV. Semi-structured interviews were conducted in Australia between 2012 and 2014 with 27 HIV-positive people not using treatment at the time of interview. Thematic analysis of views on treatment-as-prevention found that while many participants recognised potential prevention benefits, only a minority was in support of initiating treatment solely to achieve those benefits. A range of uncertain or critical views were expressed regarding who would benefit, risk reduction, and changing treatment norms. Participants resisted responsibility narratives that implied treatment should be used for the public good, in favour of making considered decisions about their preferred approach to managing HIV. Engaging communities in dialogue and debate regarding the risks and benefits of treatment will be critical if this new prevention strategy is to engender public trust.
KeywordsHIV treatment as prevention People living with HIV Australia Qualitative
Many thanks to the people who took part in interviews for this study, and colleagues who helped with recruitment, particularly the National Association of People with HIV Australia. Our thanks also go to Professor David Wilson (The Kirby Institute, UNSW Australia), who also is Chief Investigator on this study, and to all members of the study’s Advisory Committee and their organisations: NSW Health, Australian Federation of AIDS Organisations, Heterosexual HIV/AIDS Service NSW (PozHet) and Positive Life NSW. The study was partly funded by a Project Grant (1021790) from the National Health and Medical Research Council. Centre for Social Research in Health projects are partly or fully funded by the Australian Government Department of Health.
- 4.Rodger A, Bruun T, Cambiano V, et al. Abstract 153LB: HIV transmission risk through condomless sex if HIV+ partner on suppressive ART: PARTNER study. Conference on Retroviruses and Opportunistic Infections 2014. Boston, USA 2014.Google Scholar
- 6.Clinton HR. Remarks on “Creating an AIDS-Free Generation”. 2011: http://www.state.gov/secretary/rm/2011/11/176810.htm.
- 8.UNAIDS. Treatment 2015. Geneva: Joint United Nations Programme on HIV/AIDS. 2012: http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2013/JC2484_treatment-2015_en.pdf.
- 9.WHO. Guidance on couples HIV testing and counselling—including antiretroviral therapy for treatment and prevention in serodiscordant couples: Recommendations for a public health approach. Geneva: World Health Organization. 2012: http://www.who.int/hiv/pub/guidelines/9789241501972/en/.
- 11.WHO. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach. Geneva: World Health Organisation. 2013: http://apps.who.int/iris/bitstream/10665/85321/1/9789241505727_eng.pdf.
- 12.AMFAR and AVAC. An action agenda to End AIDS: critical actions from 2012 to 2016 to begin TO End the HIV/AIDS pandemic. Washington DC: amfAR: The Foundation for AIDS Research; AVAC: Global Advocacy for HIV Prevention. 2012: http://www.avac.org/ht/a/GetDocumentAction/i/44984.
- 13.ACON. Ending HIV. 2013: http://endinghiv.org.au/.
- 14.Whittaker B. Australia should lead a global HIV prevention revolution. HIV Australia. 2011;9(3):7–8. http://www.afao.org.au/news/archive/australia-should-lead-a-global-hiv-prevention-revolution#.U4vDmfmSySo.
- 15.Commonwealth of Australia. Seventh National HIV Strategy: 2014–2017. Canberra: Department of Health. 2014: http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-bbvs-hiv.
- 16.Menadue D. All PLHIV can now gain access to treatment. 2014: http://napwa.org.au/pl/2014/03/all-plhiv-can-now-gain-access-to-treatment.
- 17.Mao L, Adam P, Kippax S, et al. The evolving views and practices of antiretroviral treatment (ART) prescribers in Australia. Med J Aust [in press].Google Scholar
- 23.Dowsett G. Prevention as hyperbole; culture as concupiscence. HIV Australia. 2013;11(1):43–45. http://www.afao.org.au/library/hiv-australia/volume-11/vol.-11-number-1/prevention-as-hyperbole.
- 24.Imrie J, Elford J, Kippax S, Hart GJ. Biomedical HIV prevention—and social science. Lancet 2007;370(9581):10–11.Google Scholar
- 34.Race K. The undetectable crisis: changing technologies of risk. Sexualities. 2001;4(2):167–189.Google Scholar
- 36.The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2014 HIV Supplement. Sydney: UNSW NSW 2052. 2014: http://kirby.unsw.edu.au/sites/default/files/hiv/resources/HIVASRsuppl2014_online.pdf.
- 37.Commonwealth of Australia. Australia’s health system—an overview. 2014: http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/australiasHealthSystem.
- 38.Newman CE, de Wit JBF, Crooks L, Reynolds RH, Canavan PG, Kidd MR. Challenges of providing HIV care in general practice. Aust J Prim Health [in press].Google Scholar
- 39.Bryman A. Social research methods. 4th ed. Oxford: Oxford University Press; 2012.Google Scholar
- 43.HALC. Disclosing your HIV status: A guide to some of the legal issues. Sydney: HIV/AIDS Legal Centre. 2013: http://halc.org.au/wp-content/uploads/2012/10/Final-Version-for-distribution.pdf.
- 45.de Wit JBF, Adam P. Revolution or evolution: What can approaches based on the use of antiretroviral drugs contribute to HIV prevention in gay communities in high income countries? In: Eaton LA, Kalichman SC, eds. Biomedical Advances in HIV Prevention: Social and Behavioral Perspectives: Springer; 2014. pp. 181–204.Google Scholar
- 48.UNAIDS POLICY BRIEF: the greater involvement of people living with HIV (GIPA). 2007: http://www.unplus.org/downloads/jc1299_policy_brief_gipa.pdf.