Unexamined Challenges to Applying the Treatment as Prevention Model Among Men Who Have Sex with Men in the United States: A Community Public Health Perspective

Excerpt

Last year’s HIV Prevention Trials Network 052 study documented substantial reductions in HIV transmission to partners by persons living with HIV who had initiated early antiretroviral treatment [1]. The study’s initial findings revealed that just one new HIV infection traceable to a treated partner occurred in the early treatment arm, whereas 27 such new infections occurred in the delayed treatment arm. This difference represents a 96 % reduction in new infections amongst partners of those who took antiretroviral treatment throughout the entire course of the study. Seeking to meet the National HIV/AIDS Strategy goal of reducing new infections 25 % by 2015, the Centers for Disease Control’s new High Impact Prevention approach for the United States now prioritizes expanded HIV testing and antiretroviral treatment [2]. Even before the release of HPTN 052 results, expanded HIV screening and treatment in the U.S. had been modeled to be cost effective, though only moderately successful in reducing new infection rates [3]. Recently, HPTN 052’s principal investigator noted “The HPTN 052 trial demonstrated nearly complete prevention of HIV transmission by early treatment of infection, but the generalizability of the results to other risk groups-including injection drug users and men who have sex with men (MSM)-has not been determined” [4]. …