I have a few issues with treatment as prevention (TasP). More specifically I have issues with Public Health England trying to pass off the recent drop in HIV as predominantly due to TasP and other mutlifactorial approaches including more regular HIV testing. I have issue with this for several reasons. Here they are:
In the U.K. we have excellent free HIV care. We treat people living with HIV because we have to – otherwise we’d die. Simples. But when I start seeing bodies like PHE tagging substantial drops in HIV to TasP over PrEP my bullshit alert goes into overdrive. We have to treat people living with HIV or we’d die, I’ve said that already but how convenient is it for people managing budgets to then attribute drops in diagnoses to this ‘treatment’ – VERY! If you can spin this shit you remove the need for an appropriate prevention budget/spend. Which hasn’t been upscaled in years as it is. It was lacking years ago – it’s even more lacking today. I’m not buying that. And I will challenge anyone who tries to spin this.
Then by focusing on TasP rather than PrEP we are ignoring a very key fact. The HIV epidemic in the U.K. is not being driven by HIV+ people. Let me explain, the majority of people diagnosed with HIV in the UK are on treatment and virally suppressed. We’re talking 80%-95% depending on which aspects you look at. That means that HIV in this country is being driven by “HIV negative” people. Or more accurately people who have seroconverted since their last HIV test and are unaware. I saw some data over the last few days that suggested the average HIV test lapse times are 2 years. Treatment as prevention is not gonna help here! PrEP will! PrEP is and PrEP scaled up WILL!
Then there is this suggestion with a focus on TasP that us people living with HIV are somehow responsible for managing HIV prevention for our sexual networks and our communities- WE ARE NOT! Our treatment needs to be first of all seen and respected as treatment. NOT PREVENTION. It is each HIV negative person’s responsibility to maintain their HIV negative status. I say that as a person living with HIV who embraces and encourages TasP but also as my former HIV negative self too. It was always my responsibility. It is yours too.
And on the topic of more regular HIV testing for super high at-risk people! Wise up! If you gave these people PrEP you wouldn’t need this!! We could then focus on other STIs and actually we could maybe focus on other stuff above and beyond “disease” and “infection” and “prevention” and “risk” we could actually maybe start to look at the person and ask about feelings and worth and HEALTH.
Finally all this only works for people linking into care. What we have done here in the U.K. with self sourcing PrEP is we have created a community health care system. I genuinely believe we are reaching people who can’t or don’t want to link into care. This is a double edged sword. It creates as many concerns as it does reassurances. But ultimately we are missing an opportunity here. Online and self managed sexual health is they way forward. It is the ONLY way some people will be able to or want to engage with sexual health. Why are we not building on this?