In order to successfully leverage the use of antiretrovirals (ARVs) as a way to combat HIV transmission, programs need to be carefully modified to work in synch with the needs of each local culture, according to a new global report published by RAND Europe and the AIDS Foundation of Chicago. Recent research on HIV treatment as prevention (TasP) has shown that ARVs can successfully lower the risk of transmission, both in serodiscordant couples in which the HIV-positive partner is on meds and in high-risk HIV-negative people who regularly take the ARV tenofovir as a prophylactic.

The report, which is available by open access online and is called Mapping Pathways: Developing Evidence-Based, People-Centered Strategies for the Use of Antiretrovirals as Prevention, serves as a wellspring of information that prevention groups around the globe can use for tailoring their own programs. In addition to conducting a literature review of 520 journal articles published between 2011 and 2012, the study authors surveyed more than 1,000 global grassroots HIV advocates and interviewed several dozen key players in the HIV field around the world.

The report found three major challenges facing TasP programs:

  • Social factors that determine access to health care are as important as individual behaviors.
  • Stakeholders need more information about implementing TasP programs in order to deduce if they are feasible and appropriate.
  • Local groups need to tailor their prevention strategies to suit their own particular needs.
“Different countries and communities are at different places,” Dr. Linda-Gail Bekker, deputy director of the Desmond Tutu HIV Foundation in South Africa and a partner in the group that produced the report, said in a release. “We all have to ask policy makers, funders and ourselves a host of questions. How will we implement a certain strategy? How will we pay for it? Is it for the generalized epidemic, or is it only for certain key populations? What are the social factors that make certain populations vulnerable? Is this strategy ethical? Does it make sound public health sense? What won't be afforded if we go this route? Who will benefit if we do?”

To access a copy of the study, click here.

To read a release on the study, click here