Ethics & Engagement across the Wellcome Trust Major Overseas Programmes

Impact of WHO HIV treatment guidelines on MSM research community engagement activities

Happy New Year everyone.

In September 2015 WHO released new HIV treatment guidelines recommending immediate treatment for all individuals that test positive for HIV regardless of their CD4 cell count. These guidelines are pegged on the evidence that earlier use of ART results better, long-term clinical outcomes for people living with HIV as well as reduce transmission and decrease HIV acquisition risk at the population level. Concerns have however been raised regarding the approach including the potential of not getting the services to those who really need them like the key affected populations (this may be a genuine but debatable ethical concern). Thinking aloud though, I am wondering on what this may mean for community engagement. Will universal treatment normalise HIV and change engagement strategies? or will the strategy make it difficult for key populations to access HIV care and treatment and further make community engagement complex?

What is you take?

Views: 172

Comment by Lindsey Reynolds on January 19, 2016 at 15:21

Hi Bernadette! Thanks for the post. This is a great provocation to think through the ethics of the implementation of new technologies and a broader concern with distributive justice and equity in global health research and implementation. I've been writing and thinking around exactly this issue a lot myself at the moment, in the work I'm doing with 'universal test and treat' trials in South Africa and elsewhere. My colleagues and I have been talking about this big question of the 'missing 10%' in the implementation of these new guidelines, or those individuals who fall outside of the WHO 90-90-90 goals (For those who don't know this concept: it's a set of goals for HIV prevention programs, which are based on modeling that suggests that the HIV epidemic can be interrupted if we can get 90% of people to test regularly, 90% linked to care, and 90% adherence). Happy to chat more offline if you're interested in engaging in the conversation further. :)

Comment by Bernadette Kombo on January 20, 2016 at 7:04

Hi Lindsey! Thank you for your thoughts on this. It's indeed an areas to critically think about, and I would be interested to learn from your experiences so far. Lets take this conversation forward. 



Comment by Lindsey Reynolds on January 21, 2016 at 9:13

Hi Bernardette! If you're keen to discuss more, feel free to drop me a line at lindsey_reynolds@brown.edu

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