The Council of Representatives is being asked to adopt as APA policy the Resolution on Combination Biomedical and Behavioral Approaches to Optimize HIV Prevention. The justification for the resolution is provided in Exhibit 1.
Thirty years after the initial discovery of the virus that causes AIDS, the epidemic continues to spread, both nationally and globally, and it continues to affect millions of individuals across the developmental spectrum (UNAIDS, 2010). Although daunting challenges remain, there have been major advancements in biomedical approaches to reduce HIV transmission during the past 10 years as a result of the increased tolerability and decreased cost of anti-retroviral treatment (ART) and vaccines (e.g., Hepatitis B, HPV vaccine), the expanding range of medical options (e.g., male circumcision, microbicides), and improvement in technological approaches (e.g., female condom). The interest in biomedical approaches has dramatically increased in recent months with the release of findings from the CAPRISA 004 (Karim et al. 2010), the iPrEx (Grant et al. 2010), and HTPN052 [National Institute of Allergy and Infectious Diseases (NIAID), 2011] trials.
South African scientists associated with Caprisa, a Durban-based research center, announced in July 2010 that women who used tenofovir, a vaginal microbicidal gel containing an antiretroviral medication widely used to treat AIDS, were 39 percent less likely over all to contract HIV than those who used a placebo (Weiss et al. 2008). Even more impressive, those women who used the gel most regularly reduced their chances of infection by 54 percent (Karim et al. 2010). In November 2010, scientists associated with the iPrEx (Pre-exposure Prophylaxis Initiative) trial reported that the HIV infection rate in HIV-negative gay men who were given a daily dose of truvada (a pill containing two HIV drugs [tenofovir plus FTC] was reduced by 44 percent, compared with men given a placebo (Grant et al. 2010). In May of 2011, results were released from the HIV Prevention Trials Network (HPTN) 052 study (NIAID, 2011) indicated that initiation of antiretroviral therapy (ART) reduced transmission from HIV+ men and women to their seronegative sexual partners by 96%.
For many, the results from these three recent studies constitute “game-changing events” suggesting the need to prioritize biomedical over behavioral approaches to HIV prevention. However, close inspection of the results demonstrates that biomedical approaches to HIV prevention are optimized when they are combined with behavioral approaches. Although biomedical approaches to HIV prevention such as “test-link-and-treat strategies” and pre- and post-exposure prophylaxis are important tools for HIV prevention, in order to optimize prevention outcomes, they must be combined with evidence-based behavioral strategies including structural interventions that increase access to services, decrease costs, and reduce stigma and discrimination to ensure broad-scale implementation (Morin et al., 2011).
The debate over the value of biomedical versus behavioral approaches to HIV prevention can affect funding decisions associated with the implementation of the National HIV/AIDS Strategy (NHAS) released by President Barack Obama in July. The NHAS is intended to guide our national efforts to reduce HIV/AIDS incidence, increase access to care, and reduce HIV-related health disparities.
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