HIV This Week

Remien RH, Berkman A, Myer L, Bastos FI, Kagee A, El-Sadr WM. Integrating HIV care and HIV prevention: legal, policy and programmatic recommendations. AIDS. 2008; Suppl 2:S57-65.

Since the start of the HIV epidemic we have witnessed significant advances in our understanding of the impact of HIV disease worldwide. Furthermore, breakthroughs in treatment and the rapid expansion of HIV care and treatment programmes in heavily affected countries over the past 5 years are potentially critical assets in a comprehensive approach to controlling the continued spread of HIV globally. A strategic approach to controlling the epidemic requires continued and comparable expansion and integration of care, treatment and prevention programmes. As every new infection involves transmission, whether vertically or horizontally, from a person living with HIV, the integration of HIV prevention into HIV care settings has the potential to prevent thousands of new infections, as well as to improve the lives of people living with HIV. In this paper, Remien and colleagues highlight how to better utilize opportunities created by the antiretroviral roll-out to achieve more effective prevention, particularly in sub-Saharan Africa. The authors offer specific recommendations for action in the domains of healthcare policy and practice in order better to utilize the advances in HIV treatment to advance HIV prevention.

Editors’ note: Control of the global HIV epidemic remains elusive with poor coordination, underutilisation of effective interventions to slow the epidemic, and suboptimal expansion of prevention, treatment, care, and support programmes. This paper reviews some basic biological, epidemiological, and behavioural concepts that underpin potential synergies between care/treatment programmes and effective prevention. Failure to retain patients in care and failure to support high levels of adherence in those on antiretroviral therapy have negative consequences for both individuals and for public health. Integration of HIV prevention into HIV care and treatment programmes for people living with HIV is a key strategy advocated here.