Abstract
According to current global AIDS guidelines, HIV testing is key to the success of the 'treatment as prevention' (TasP) strategy and the control of AIDS. In view of Brazil's commitment to these guidelines, this article characterizes the principles and justifications underpinning TasP and discusses implementation challenges. The analysis draws on a systematic review of the literature (2005 to 2015) on recruitment and testing strategies for men who have sex with men. This approach was adopted based on the assumption that current knowledge on HIV testing can offer valuable insights into the foundations of global AIDS policies and their uptake in local contexts. Based on the analysis of the 65 articles selected, we suggest that TasP represents a shift in the AIDS prevention paradigm. There is an overlap between prevention and care and the new approach places major emphasis on biomedical and psychological knowledge. The TasP approach fails to address the factors associated with HIV vulnerability and the stigma surrounding AIDS and undermines the participation of activists and PLWHA as autonomous producers of preventive of preventive practices. We argue that, to ensure the effective implementation of TasP in Brazil, it is necessary to discuss issues such as the protection of human rights and the structural problems facing Brazil's public health system.
Highlights
In 2014, the United Nations launched UNAIDS, a strategy to end AIDS by 2030 based on achieving the 90–90–90 targets: 90% of all people living with HIV will know their HIV status;90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have durable viral suppression1
The main differences between the Voluntary Counseling and Testing (VCT) and treatment as prevention’ (TasP) strategies identified in the literature systematized in Chart 3 illustrate the emergence of a new prevention paradigm centered on TasP
This approach is characterized by the expansion and diversification of testing provision aimed at improving diagnosis, whereby routine testing is touted as a strategy to encourage preventive practices
Summary
In 2014, the United Nations launched UNAIDS, a strategy to end AIDS by 2030 based on achieving the 90–90–90 targets: 90% of all people living with HIV will know their HIV status;90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have durable viral suppression. ‘Treatment as prevention’ (TasP) is key to meeting the 90-90-90 targets because this strategy makes it possible to reduce the circulation of HIV among the population, breaking the chain of transmission. For this to happen, the infection should be diagnosed as early as possible and followed by antiretroviral therapy (ART). The strategy was developed based on evidence indicating that antiretroviral drugs provide protection from HIV infection and that undetectable viral load greatly reduces the risk of HIV transmission. It falls on the health sector to promote the expansion of testing, for key populations at higher risk, identify HIV-positive individuals, and ensure treatment access and adherence
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