Universal voluntary HIV testing and immediate antiretroviral therapy

Abstract

The theoretical model by Reuben Granich and colleagues1Granich RM Gilks CF Dye C De Cock KM Williams BG Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model.Lancet. 2009; 373: 48-57Summary Full Text Full Text PDF PubMed Scopus (1493) Google Scholar concludes that a massive scale-up of HIV testing with immediate initiation of antiretroviral therapy could nearly stop HIV transmission. Writing on behalf of a group of advisers to UNAIDS on HIV and human rights,2UNAIDS Reference Group on HIV and Human RightsTime for action towards universal access to prevention, treatment, care and support: beyond theory towards practice and protection. UNAIDS, Geneva2008Google Scholar we welcome a model that proposes the attainment of universal access to HIV treatment and HIV testing, and confirms the link between HIV prevention and treatment; these are essential components of the right to health which must be pursued with much greater efforts. Granich and colleagues acknowledge many barriers to implementation, but neglect a crucial issue: whether universal annual testing and immediate treatment can be applied safely and acceptably in the face of widespread HIV-related stigma, discrimination, and human rights abuses. There is abundant evidence that the uptake of HIV prevention and treatment programmes is undermined by gender inequality and violence against women, stigma and discrimination against people living with HIV, and the criminalisation or denial of the existence by some governments of populations at high risk of HIV—eg, men who have sex with men, people who use drugs, and sex workers. The model would have been stronger had it costed concrete programmes to reduce these barriers and support people's ability to access services. Without attention to such programmes, the model would not achieve the posited uptake necessary to achieve its goals. If efforts to determine the model's potential are deemed worthy of study, it is imperative that not only HIV testing and treatment be scaled up, but also programmes to protect and promote human rights of people living with and vulnerable to HIV.3Open Society InstituteHuman rights and HIV/AIDS: now more than ever. Open Society Institute, New York2008http://www.soros.org/initiatives/health/focus/law/articles_publications/publications/human_20071017Google Scholar Additionally, people living with and affected by HIV should be involved. We declare that we have no conflict of interest. Universal voluntary HIV testing and immediate antiretroviral therapy – Authors' replyWe thank the many colleagues around the world who have commented on our theoretical paper, and are encouraged by the ongoing discussion about how best to use antiretroviral therapy for HIV prevention. These comments signal that more research is needed. Full-Text PDF