Treatment as prevention: A strategy for eliminating the HIV/AIDS epidemic or a potential misallocation of scarce resources?

Well into its third decade,the HIV/AIDS pandemic remains a global public health challenge. An estimated 33 million people are infected and approximately 2.6 million deaths are caused yearly by the virus(UNAIDS,2010). Reducing the number of new cases continues to be an enormous problem. It is believed that about 4-6 new people are infected for every individual treated(Cohen,2009). Prevention programs have become more effective and yielded some positive outcomes,but historically,it has been difficult to precisely measure their impact. Although there have been some promising recent discoveries in the search for a vaccine(IAVI,2011),none will be available in the short-term. Currently,the uses of antiretrovirals(ARVs)for prevention has gained wide acceptance among AIDS researchers. Enthusiasm for ARVs for prevention was ignited by the findings of three recent studies. Two of the trials reported that providing ARVs to persons who did not have the virus(pre-exposure prophylaxis[PREP])was 62%-73% effective in blocking the transmission of HIV. A third trial showed that earlier treatment with ARVs for persons who were infected produced a 96% reducation in virus transmission. The fervor for Treatment as Prevention has grown in a time of austerity. Funding for treatment and prevention has been flat or declined. Debates among policy makers have focuesd on spending countries' HIV prevention budgets on Treatment as Prevention. This paper explores ethical and clinical implications of implementing national programs of Treatment as Prevention in developing and industrialized countries.