Tas p sean slavin

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Information about Tas p sean slavin
Health & Medicine

Published on October 24, 2014

Author: AFAO

Source: slideshare.net


This presentation was given at the AFAO National HIV Forum, 17 October 2014.

1. Treatment as Prevention ….next steps Sean Slavin AFAO Health Promotion Program

2. Increasing treatment is now strategically embedded. TasP? more cautious.

3. The place of TasP

4. Balancing evidence and action  Already have good evidence – not perfect or complete, but it never is  Knowledge generated from clinical trials will always have limitations – they are not real world settings  We can move forward on resolving the political, ethical, health promotion & policy issues

5. Efforts so far to promote TasP

6. Value in maintaining distinction between treatment for clinical benefit & for prevention • Priority in decision making should be individual health. This is particularly important at commencement. • Condom use or changed sexual practice is an entirely feasible prevention approach prior to treatment. • Treatment information delivered to PLHIV in the context of health maintenance is complex. • Treatment as Prevention must include HIV negative people and this means the communication will be very different. • Allows us to be clearer about the prevention benefits

7. Some questions… In combination?  TasP is an element of combination prevention understood as a population health approach.  What does combination prevention look like for individuals?  Can TasP be a standalone risk reduction strategy?  Can we imagine a health promotion campaign that endorses condomless sex when TasP is effectively used instead?  Or is TasP like a vaccine? Offering a kind of herd immunity & no effect on individual behaviour.

8. Which target groups?  heterosexual couples?  gay male couples?  ‘stable’ or monogamous couples?  Sex outside the relationship?  Casual sex?

9. What does TasP consist of?  Treatment practices  Monitoring practices  A relationship agreement  A roadmap for couples  How might the neg partner be supportively involved in treatment?

10. TasP and HIV negative people?  How should we communicate with HIV negative people about TasP?  Broader gay community?  How should we support HIV positive people using TasP to communicate with their sexual partners?  Are we sufficiently clear that TasP requires the informed consent of all participants in the sex?

11. Working with ‘undetectable’  Low level viremia?  Viral load blips clinical v. psychological significance.  Is ‘undetectable’ the ‘new negative’?

12. HIV treatment and undetectable viral load 63.2% 86.8% 74.8% 90.5% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% HIV-positive men on treatment Undetectable viral load (men on ART) HIV-positive men represent ~9% of gay men in the national GCPS sample. HIV treatment uptake has increased over last 10 yrs (p<.001) and last 3 yrs (p=.001). Undetectable viral load has increased over last 10 years (p<.001) but has stabilised over last 3 yrs. 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Source: Gay Community Periodic Surveys, unadjusted data from six states and territories (n>5,800).

13. Legal and ethical implications of TasP  Does TasP still require disclosure?  HIV- person must consent  TasP as a reasonable precaution against HIV with a similar value to condoms?  Criminal v. public health law

14. Next steps for AFAO…  Member consultations over the coming weeks  Leading to the development of a guidance document for community based health promotion  Aim to answer many of the questions posed today and provide practical suggestions for how to proceed  Finalised by the end of the year  Expect my call.

15. In conclusion  TasP is a revolutionary technology  To become a revolution in safe sex it must be couched within a community based health promotion response  It’s time to get specific and think about programming.  It’s also time to be bold – clinical trials will never provide perfect evidence. We can develop a range of responses to uncertainty – political, social, cultural, sexual.

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