35,000,000 30,000,000
25,000,000 20,000,000 15,000,000
LHIV
10,000,000
Need ART
5,000,000
On ART
People
Data: UNAIDS Towards Universal Access, Progress Report 2009
Everyone seem to agree that we need more HIV testing and more PLHIV under ART › However, some main barriers come from:
No sense of urgency and unwillingness to speed up Opt in testing (passive way) Generating a false debate between public health vs. human rights Continuous involvement of religious/moral believes when tailoring communication and information strategies Thinking that the only solution is more money instead of trying more efficient responses.
1) 2) 3)
ď‚ž
Growing scientific (medical) evidence shows that provision of ART to PLHIV, could be an effective strategy to achieve population-level reductions in HIV transmission (1,2,3)
ď‚ž
Sexual behavior change interventions are slow to reach large populations and high cost makes them impractical for many countries
Deborah Donnell et al .The Lancet, May 27, 2010 Julio SG Montaner et al. The Lancet August 2006 Velasco-Hernandez JX, et al. Lancet Infect Dis. 2002
ď‚ž 1)
Increase HIV testing: current VCT model doesn´t help
VCT model: originally designed when: a) ART was not available (accessible), b) Majority of people believed: AIDS=Death, c) There were no rapid HIV tests d) Investing a lot of time was needed on pre- counseling
2)
Some evidence shows that VCT does not change sexual behavior when the result is negative (4), meaning that 9 out of 10 will not change their sexual practices after VCT.
3)
Then we need to change from VCT
VTC
(4) Guy Marks et al. Meta-Analysis of High-Risk Sexual Behavior in Persons Aware and Unaware They are Infected With HIV in the United States Implications for HIV Prevention Programs. J Acquir Immune Defic Syndr Volume 39, Number 4, August 1 2005.
Are people willing to get a rapid HIV test in an open public place? No,
because of stigma No, because of discrimination No, because of confidentiality
From mathematical model of universal testing (5) to “Testing Millions Campaign”(6)
UGANDA
MEXICO
ESTONIA
SWAZILAND
INDIA
(5) Granich RM, et al. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009 (6) “Testing Millions Campaign” AIDS Healthcare Foundation http://www.aidshealth.org
Imaginary future scenarios just before sex
1)
When you decide to have sex without condom (BB), ask your sex partner if he´s HIV positive or do him a rapid test, wait 10 minutes, see the result and then sex
2)
If your partner is positive and you are negative, ask him if he is under ART and undetectable, if he´s not sure or you don´t trust him, just do him a rapid viral load test, wait 20 minutes and then sex
Beware: 1) 2)
HIV Rapid tests are not currently available for individuals Rapid viral load test does not exist (yet)
or
and
or
or
or
and
or
and
or
and
and
and