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Remedicalizing an epidemic: from HIV treatment as prevention to HIV treatment is prevention

Nguyen, Vinh-Kima,c; O’Malley, Jeffreyb; Pirkle, Catherine M.c

doi: 10.1097/QAD.0b013e3283483697

aClinique médicale l’Actuel, Montréal, Québec, Canada

bHIV/AIDS Practice, UN Development Programme, New York, USA

cSchool of Public Health, Université de Montréal, Montréal, Québec, Canada.

Correspondence to Catherine M. Pirkle, School of Public Health, Université de Montréal, 1430 boul. du Mont-Royal, Outremont, Montréal, Canada. E-mail:

Received 30 March, 2011

Accepted 26 April, 2011

The response by Delva et al. [1] to our article contributes to a more integrated response to the challenges of the HIV epidemic to come. We agree that treatment and prevention should not be pitted against each other, even though this is often the case in the way in which funding is allocated and energies spent on the ground. In discussing the contribution of primary infection to HIV transmission, they are right to stress that local epidemics may vary significantly in this regard. The high proportion of acute infection to forward transmission has been documented in mainly MSM populations in the north, but there is comparatively little data on MSM or injection drug user populations in Africa, for instance, where circumstances differ. Our original commentary was written in response to a rather disturbing trend visible at the Vienna AIDS conference where activism and human rights were at times cast as impeding progress in the fight against AIDS. We agree that we must all work together and stress that involving communities affected by HIV and building their capacity to enact and sustain broader social transformations are necessary foundations for biomedical prevention to be effective over the long term. However, we caution that an overt emphasis on biomedical technologies risks eclipsing the importance of social change as the fundamental basis for prevention.

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1. Delva W, Verguet S, Hargrove J, Williams B, Sheneberger R, Stander T, Welte A. Treatment-centred prevention: an integrated biomedical and social approach to HIV prevention. AIDS 2011; 25:1435–1437.
© 2011 Lippincott Williams & Wilkins, Inc.