Because prevention isn’t working

It’s common sense that testing and treatment will reduce the severity of the AIDS epidemic, but you don’t embark on multi-million dollar public health initiatives without evidence.

Reported in the Washington Post:

A combination of universal voluntary HIV testing and immediate antiretroviral treatment (ART) following diagnosis of HIV infection could reduce HIV cases in a severe generalized epidemic by 95 percent within 10 years, a World Health Organization study finds.

In an accompanying comment on the study, Professor Geoffrey P. Garnett of Imperial College London, U.K., wrote that this type of HIV control strategy “would reflect public health at its best and its worst.”

“At its best, the strategy would prevent morbidity and mortality for the population, both through better treatment of the individual and reduced spread of HIV,” Garnett wrote. “At its worst, the strategy would involve over-testing, over-treatment, side-effects, resistance, and potentially reduced autonomy of the individual in their choices of care. The individual might gain no personal benefit from testing and early treatment, but they would benefit from protecting partners — and who could object to that, unless they were recklessly exposing others to infection?

“It is easy to see how enforced testing and treatment for the good of society would follow from such an argument. Partial success would lead to infection becoming concentrated in those with a high risk, with an increased danger of stigma and coercion,” Garnett wrote.

All other things being equal, it is better to treat the socioeconomic conditions which perpetuate HIV infections than to treat the virus itself. But in the meantime, poverty persists and we have relatively cheap and effective drugs for HIV/AIDS, so treatment is a decent stopgap effort.

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