1. www.ias2011.org Treatment as Prevention: Report back from the Vancouver Workshop How treatment as prevention affects individuals: perspective from community Eric Fleutelot – Sidaction

2. www.ias2011.org TasP: a revolution Community mobilization: a key role in successes of HIV prevention, care, treatment and support TasP: perceived as a prevention revolution –Hope and relief –Potentially could endanger good practice

3. www.ias2011.org What kind of revolution ? French revolution-like : –Eventually less power to the people, –A new elite becoming more powerful (health leaders and theory guys of public health) A democratic revolution –For and by people living with HIV, finally freed from the fear to pass virus to partners

4. www.ias2011.org A revolution for the people Effectiveness of treatment in the prevention of HIV transmission –Non sexual transmission: Vertical transmission IDUs –Sexual transmission HPTN 052 being the latest example TasP affects individuals tremendously: –PLHIV no longer infectious –New counselling in a risk-reduction approach –Easier to plan pregnancy

5. www.ias2011.org TasP An opportunity to discuss about people living with HIV’s sexuality Means earlier treatment –Advantages for individuals: Better immune and virological outcomes, Fewer aids-related diseases, Reduced mortality and better survival expectancy, But we need to be sure it’s a clear benefit. HIV, a chronic disease, but not like others –High level of stigma

6. www.ias2011.org Implementing TasP Numerous challenges –High level of stigma and discrimination –Hard to disclose –HIV highly prevalent among discriminated and marginalized people IDUs, MSM, sex workers, inmates, … Real world does not stick to mathematical models

7. www.ias2011.org Challenges 60% of HIV+ aware of their HIV status not linked to care Rethinking Prevention of HIV Type 1 Infection, David N. Burns, Carl W. Dieffenbach, and Sten H. Vermund, Clinical Infectious Diseases, Volume51, Issue6 Pp. 725-731. In Burundi: –250 000 HIV+ people, –60 000 should be on HAART, –23 000 are actually on HAART.

8. www.ias2011.org Challenges (2) GNP+ statement after HPTN 052 was made public: –“…, in order to realize both the individual and public health benefits of treatment, it is important that the rights of people living with HIV are recognized and protected.” Every individual should decide when and how to start a treatment.

9. www.ias2011.org Challenges (3) TasP could be used to convince political and financial leaders to invest more in access to care and treatment, but we have to ensure that No one is forced to get tested or is tested without their consent or coerced into starting ART primarily for the benefit of public health rather than the health and well-being of the individual.

10. www.ias2011.org Recommendations Review counseling and medical for –Sero-discordant couples –Pregnant positive women –For the general population Focus more on –MSM, Sex-workers, IDUs, inmates, –Anal sex (both in homosexuals and heterosexuals)

11. www.ias2011.org Recommendations (2) Policy questions and behavioural research questions: –impact of STIs on the failures of treatment as prevention (especially in contexts were STIs are highly prevalent) –Criminalization of HIV transmission –Sexual behavior

12. www.ias2011.org Thanks to my colleagues and friends All my colleagues at Sidaction – France and more specially Ms. Veronica Noseda Mr. Bruno Spire – Aides – France Mr. Edwin J. Bernard – UK (and Germany too!) Dr. Marie-Josée Mbuzenakamwe – Dept of Defense, US Embassy – Burundi Ms. Jeanne Gapiya-Niyonzima – ANSS – Burundi Mr. Gregg Gonzalves – USA Mr. Alain Volny-Anne – EATG (Belgium) and Action Traitements (France) and much more (Martinique)…

13. www.ias2011.org THE ITALIAN GOVERNMENT STILL OWES 260 MILLION EUROS TO THE GLOBAL FUND AND NEVER PLEDGED FOR 2011 - 2013 ITALY: KEEP THE PROMISE, NOW! FUND THE FUND, NOW! AIDS, TUBERCOLOSIS AND MALARIA WILL NOT WAIT!