You are right, it is both clear and difficult. It is difficult because first you need funding and political will. IDUs and sex workers are rarely considered priority populations from the point of view of governments, but in concentrated HIV epidemics such as there are in Central Asia, these are exactly the populations that need to be prioritized.
Next, the populations themselves are difficult to reach. Because of stigma and discrimination, as well as the criminalization of sex work and drug use, people who engage in these activities are hidden. To reach them, we have to draw them out to drop-in centers that attract them with needed services, or find them with outreach workers who know and understand the population.
There is still something missing in the monitoring of TB/HIV activities that would be worth collecting. TB and both ART and pre-ART patients are currently being assessed in cohorts and their outcome measured according to standardized categories. However, little is known about the outcome of co-infected individuals, since their details get mixed with the overall cohort they belong to.
Main messages from the CCABA (Coalition on Children Affected by AIDS) – a two day symposium with most of the major players in the OVC sector participating.
our programs should nonetheless endeavor to gather as much data on other aspects of care as possible and to find time for elaborating and analyzing more health information. This could produce two essential results. First, by doing so we should be able to look at the broader picture of our intervention as far as health care services are concerned. Secondly, we could be more informed and authoritative in documenting our findings, supporting our views, and contributing to the design of future programs.
Continuing the conversation about more effective use of the newer medications to improve efficacy and decrease toxicity in HIV patients.
The IAS-USA Treatment Guidelines were released during the conference, supporting earlier initiation of treatment with ART recommended for all patients with CD4 counts < 500, selected clinical conditions, and all symptomatic patients (provided patients are ready to start therapy: “The patient must be ready and willing to adhere to lifelong therapy,” the document explicitly states. Additional populations for ART initiation included pregnant women, and those with acute primary infections. The document is well worth a good read for its careful review of the data behind the pendulum swinging to earlier initiation in 2010.
You must understand basic human needs when you’re talking about HIV; for example, you can’t talk to people about prevention if they don’t have something to eat today. Organizations work the same way. Look at their hierarchy of needs; they must keep money flowing, so strengthening those systems first is essential.
President Clinton and Bill Gates Address International AIDS Conference
Using HIV treatment as a strategy for prevention of HIV transmission.
Bottom line: HIV probably does increase risk but not as much as some of the more traditional modifiable risk factors (like smoking). Hopefully, in the future the START study results whether treatment practices should be changed. .