HIV Science & Policy
AIDS advocacy requires keeping up with HIV/AIDS science, clinical data, treatment guidelines, and social science/implementation research. Advocates must be sensitive to new and emerging evidence and be willing to push for innovation, experimentation, and policy change even when evidence trends positive but is not yet conclusive. In particular, advocates must be involved in policy setting arenas where treatment guidelines are created at international and national levels and they must fight for the adequate resources and policy changes to implement evidence-based implementation of universal access to comprehensive, treatment, prevention, and care and support.
Some of the most significant recent advances HIV science involve evidence that earlier initiation of effective anti-retroviral therapy results in significant decreases the risk of transmission to serodiscordant heterosexual partners. In the now famous 2011 HPTN 052 study, the risk of horizontal transmission to HIV-negative partners was decreased by 96% when the HIV-positive heterosexual partner started successful suppressive ART at a 550 CD4 cell count compared those who waited until the current WHO guideline standard of a 350 CD4 cell count. There is strong scientific plausibility that the positive prevention benefits of early treatment extend to non-regular heterosexual partners, to same sex sexual partners, and to needle-exchange partners. In the same vein, there is growing scientific and policy support for initiation of life-long ART for women who are pregnant regardless of CD4 cell count, with expected benefits in terms of maternal health and reductions in the risk of vertical and horizontal transmission. There is also emerging positive evidence that earlier treatment initiation has positive clinical morbidity and mortality benefits for patients living with HIV, which has resulted in US guidelines currently recommending the offer of voluntary treatment at any CD4 cell count.
In addition to this positive scientific evidence, there is growing social science evidence of the benefits of integration of HIV services within antenatal and maternal and child health services and of greater integration and coordination with TB detection, prevention, and treatment services. Greater empowerment of PWAs, community system strengthening, devolvement of health services to the community level, stronger support for testing and treatment literacy and adherence support, and greater reliance on adequately supported community health workers have all been shown to improve achievement of better quality care and improved connections to care.
Health GAP is committed to translating the lessons of emerging science and social science into implementable policies. Accordingly, we have been involved in policy setting initiatives within PEPFAR and USAID, at WHO, at the Global Fund to Fight AIDS, TB and Malaria, and Kenya, Uganda, and other African countries. Health GAP partners with a coalition of international allies who are similarly committed to the realization of the promise of HIV science. In particular, we are actively engaged in efforts to ensure that PWAs in developing countries have full access to the newest point-of-care diagnostics and medicines and that intellectual property and trade policies do not interfere with such access.