VANCOUVER, Canada -When Francois Venter of Wits Reproductive Health and HIV Institute in South Africa got news of UNAIDS 90-90-90 goal last autumn, he told a morning audience here, he wasn’t eager to embrace another international agency target. But as targets go, this was not a bad one, he realized. At least 90 percent of people with HIV knowing it, at least 90 percent of those diagnosed being treated, and treatment succeeding in at least 90 percent of those getting it, after all, is another way of saying “test and treat.”
He doesn’t have that much patience either with different ways to say “test and treat,” (including “test and offer,”) but at least, he noted, “It helps us to focus on what’s important.”
Venter took his audience on a tour of what is important with a roundup of current — and past — prevention hopes, and the challenges they face.
HPTN 052, he noted, showed that sex can be safe, “and pretty much changed the world.” The results of the Partner study, the second large trial to look at whether people with HIV become non-infectious on antiretroviral therapy confirmed that he noted. Then came the results of the Temprano trial, which showed the value of early antiretroviral treatment and preventive tuberculosis treatment in settings where the burdens of both are high, and the START trial findings, released in May and detailed here this week. Both validated the individual benefit of starting treatment for HIV when diagnosed.
“It’s easy to say we already knew the answer,” Venter said, but he added, quoting HIV treatment advocate David Barr and referring to two toxic HIV treatments since made obsolete by safer and more effective medicines, “we would have had a different answer if this had been done in the era of d4t and AZT.”
Programs that provide the medicines are improving too, he said, but unreliable supply lines still put the lives of people on treatment in the hands of often unreliable systems, he said.
He listed other changes needed to realize the test and treat goal briskly: “Less morality, more accountability,” among the first.
“We’re obsessed with what’s happening in the bedroom,” Ventor noted, reeling off some of the targets of behavioral interventions — multiple concurrent partnerships, “sugar daddies,” or older men with younger women — that have been debunked by research and continue to be cited as needed.
The behaviors that needs to change most, perhaps, he indicated, are ones toward those who need services, who participate in research. He warned the audience that a quote he was about to share, from a South Africa trial participant might be shocking. He warned again. Then he showed it:
“It kind of makes your heart break,” he added.
“Behavior changes if you provide good services,” he concluded. “We need to stop breaking our finger on the pulpit.”