It is the last few days of consultation on the new BHIVA guidelines for treatment of people living with HIV.
I am really pleased to say that there has been extensive consultation with the community of people with HIV. BHIVA had a community representative on the writing committee and also held two large consultative meetings with the community: one before Christmas and one last Tuesday. On Tuesday the room at Friend’s House in Euston was filled to the brim with a good diversity of people.
There are two extremely innovative sections in the guidelines: one dedicated to Patient Involvement in Decision Making and one on Treatment as Prevention. The latter is especially ground-braking because it acknowledges in practice the prevention revolution brought about by the HTN052 study. This was a research among couples where one partner was positive and one was negative, who were not always using condoms, which proved scientifically that people on HIV medications are 96% less likely to transmit HIV.
It’s a fact: there are HIV positive people who are not able to use condoms, maybe because they want to conceive, or because they feel it interferes too much with the pleasure and spontaneity of sex, or maybe because, as a consequence of power dynamics, it can be difficult for women or young people to always negotiate condoms. Starting treatment in order to avoid passing HIV to a negative partner is acknowledged as an ethical option by the guidelines. Obviously the guidelines also include a lot about in-depth discussion with the doctor of all the ‘caveat’ and especially the crucial importance of stressing the use of condoms ( and I suggest to include female condoms! ) to further reduce the very low risk.
I feel it this is an amazing acknowledgement of the sexual and reproductive rights of people with HIV, as well as that it could contribute to reduce stigma, and finally that it also provides a strong argument to make treatment available to all.
It is not surprising and maybe not a coincidence, that this week there has also been a change in the UK policy that prevented foreigners, such as failed asylum seekers and people on a student VISA, to access HIV medication (an issue on which we had been campaigning since 2004). The rationale beyond this change was not just that it was absurd and incoherent that ‘ foreigners’ could access treatment for all infectious diseases apart from HIV ( the evil disease that needs to be singled out!). The argument for providing treatment to everybody on UK territory was very much made on the notion that this is important for public health and prevention, because people on treatment are so much more less likely to transmit HIV.
I really hope that what is happening in the UK will have even further ramification in promoting Universal Access to treatment to the millions of people who still need it, especially in the current climate of uncertainity created by the the Global Fund Crisis.
Good coverage on the change in policy on access of HIV treatment was on the Telegraph.
If you are interested in commenting on the BHIVA treatment guidelines (and can digest the 111 pages written in medical jargon….gulp!) the consultation is open until Monday 5th March.