Emerging Issues in Today's HIV Response Debate Series

Debate Six: Treatment as Prevention

The sixth debate of the Emerging Issues in Today’s HIV Response Debate Series titled, "Treatment as Prevention" featured expert panelists arguing for and against the proposition:

"Countries should spend a majority of what is likely to be a flat or even declining HIV prevention budget on 'treatment as prevention'."


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Recent studies have shown that persons living with HIV who are on antiretroviral treatment, are much less infectious and therefore much less likely to transmit HIV to others. The HPTN-052 randomised study found a 96% reduction in HIV transmission from an HIV-infected person to his/her sexual partner, for the 76% of cases where intra-couple transmission took place. Results suggesting similar levels of acquisition risk reduction were reported in the 2010 Partners in Prevention study. What do these latest results mean for HIV prevention programming? Should "treatment as prevention" become HIV prevention policy in countries? For all persons or only for adults in long-term sexual partnerships? Does the type of epidemic (i.e. concentrated, mixed, generalized) matter? How feasible are these interventions? Is it ethical not to implement them, given that their efficacy between long-term sexual partners is known? Should prevention resources be diverted away from other interventions, such as behavior change efforts, to fund increased ART? Who will pay for costs of the increased volumes of drugs? Do we know enough about the side-effects or about drug resistance? These questions and others related to treatment as prevention were discussed.

Download the Summary Report (PDF, 174 KB) to read more.

Opening Remarks

Michel Sidibé
Executive Director of UNAIDS, the Joint United Nations Programme on HIV/AIDS
Under Secretary-General of the United Nations


Nancy Birdsall, PhD, MA
President, Center for Global Development


For the Proposition

Wafaa M. El-Sadr
Director, International Center for AIDS Care and Treatment Programs
Professor of Epidemiology and Medicine
Mailman School of Public Health and College of Physicians and Surgeons
Columbia University

Sten H. Vermund
Director, Vanderbilt Institute for Global Health
Amos Christie Chair in Global Health
Professor of Pediatrics, Medicine, Preventive Medicine, Obstetrics and Gynecology

Against the Proposition

Stefano Bertozzi
Director, HIV and Tuberculosis, Global Health Program, Bill & Melinda Gates Foundation

Myron Cohen
Associate Vice Chancellor for Global Health, UNC School of Medicine
J. Herbert Bate Distinguished Professor of Medicine, Microbiology and Immunology
Public Health Director, Institute for Global Health and Infectious Diseases
Chief, Division of Infectious Diseases
Director, Center for Infectious Diseases

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