Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

The Community Consensus Statement is a joint initiative of AVAC, EATG, GNP+, ITPC, MSMGF and NAM.

This consultation page is your chance to help us write the final version of the community consensus statement. The final version, shaped by you, will be issued at the International AIDS Conference in July. It will then be available for endorsement by whoever sees it. The more people sign, the more it is likely to be adopted, so we need to make sure the statement genuinely reflects the views of the community.

We welcome all your suggestions, comments, and feedback; please add your comments to the form and submit below. We require comments in English at this stage, but feel free to translate the statement and circulate it so you can collect comments. The final version will be translated into at least four other languages.

Please send this page to your friends and colleagues so they can comment too.

Introduction

  • The aim of this statement is to state a common position of people living with HIV and at risk or affected by it on the use of anti-HIV medication (antiretrovirals or ARVs) to prevent HIV.
  • This statement addresses what we as a community view as essential for us to safeguard our health and well-being, including our freedom and power in relation to taking ARVs.

The right to HIV treatment

  • Treatment with ARV therapy (ART) has health benefits for nearly everyone with HIV. Most guidelines now recommend that potent and optimal ART with viral load monitoring should start at HIV diagnosis.
  • Access to treatment is a right under article 12 of the International Covenant on Economic, Social and Cultural Rights. Depriving people of access to treatment undermines that right.
  • People also have a right to refuse treatment or delay it if they do not feel ready or circumstances hinder it, under article 25d of the UN Convention on the Rights of Persons with Disabilities.

Access to medication

  • Access to free or affordable ARVs and the support to take them is essential for HIV treatment to work.
  • Stockouts endanger the lives of people with HIV and are a violation of human rights.
  • The cost of ARVs needs to decrease further, and across all countries, if they are to reach their full potential.
  • Patents and other intellectual property barriers should not stop any country, especially middle-income countries, getting the newest and most effective HIV drugs.
  • In many places, the people who most need HIV treatment have the worst access to it.
  • This is due to weak healthcare system capacity, stigma, persecution and criminalisation. The prevention benefits of HIV treatment cannot become a reality till these are addressed.

Preventing infection

  • If someone with HIV takes effective treatment it vastly reduces their chance of passing HIV to others.
  • HIV treatment can thus free people with HIV from a huge burden of guilt, blame and anxiety about transmitting HIV to others.
  • Treatment can also bring down the rate of HIV infection in a community by reducing the overall infectiousness of people with HIV.
  • The fact that HIV treatment reduces a person’s infectiousness is a benefit; taking treatment must not be turned into a responsibility.
  • Healthcare workers should establish that the person wishes to take ART of their own free choice. They should not pressure them into it and must provide the information they need to make their own decision.
  • We oppose any proposals to use compulsory HIV testing or treatment as public health measures.
  • We reject approaches to HIV treatment that avoid or do not provide a full informed consent process. Not to allow informed consent makes treatment coercive by default.

PrEP

  • HIV-negative people can also protect themselves from infection by taking ARVs. This is called pre-exposure prophylaxis or PrEP.
  • It is particularly urgent to make PrEP available to individuals at imminent risk of HIV.
  • It is also urgent to make PrEP available to groups that are at such risk of HIV that ART for all diagnosed will not by itself bring down the infection rate.
  • All HIV-negative people at risk of HIV should have information about PrEP. They should have the opportunity to use affordable PrEP as one of the ways they protect themselves from HIV.
  • All people receiving PrEP should have access to regular HIV and STI testing, adherence advice programmes, and side-effect monitoring.
  • PrEP is currently far too expensive to provide it to everyone who needs it. It is vital to decrease prices and remove patent barriers to the drugs used as PrEP.

Prevention policies

  • ARV or PrEP provision programmes should not exclude any group or any person seen as a member of that group. Specific efforts should be made to include stigmatised or criminalised groups.
  • The lack of treatment access for certain groups should not be a reason to oppose offering treatment to everyone at diagnosis and access to PrEP to those who need it.
  • Many people, with and without HIV, are unaware of the prevention potential of ART and PrEP and how they reduce transmission. They should have clear and accurate information about them.
  • ARVs cannot prevent other sexually transmitted infections and therefore do not replace comprehensive, competently-delivered, and well-supported sexual health programmes.
  • ARV provision, whether as treatment or PrEP, should be embedded in such programmes.
  • ARV provision should be part of the general support each person gets to sustain their health and quality of life.
  • HIV treatment and PrEP by themselves will not end the HIV epidemic. They are, however, essential components of what it will take to end it.

The Community Consensus Statement is a joint initiative of AVAC, EATG, GNP+, ITPC, MSMGF and NAM. It has been made possible by grants to NAM from Gilead Sciences and ViiV Healthcare. NAM’s funders have had no editorial control over the content of the Statement.

Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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