What does PrEP mean for people living with HIV?

Edwin J BernardCo-ordinator, HIV Justice Network

Consultant, GNP+

• “As a woman living with HIV, how I wish that we had known about PrEP then. We knew how to judge our risk and we knew that our risks of getting HIV were high; we would have taken PrEP.”

• Teresia Njoki Otieno, member of the African Gender and Media Initiative and of the International Community of Women Living with HIV.

• Quoted in UNAIDS. Success with PrEP: next steps to support policy decisions in southern and eastern Africa. 29 October 2014

What does PrEP mean for people living with HIV?

• Meaningful engagement of people living with HIV

• A common understanding to remove the false dichotomy between prevention and treatment

• Treatment for health first, prevention important secondary benefit

• Respect our sexual and reproductive health and rights

• HIV prevention is a shared responsibility• Truly universal access

The Role of PLHIV in New Prevention Technologies: Our Advocacy Agenda, 2010.

PrEP and responsibility for HIV prevention

• TasP policies may increase access to ART, but places undue HIV prevention burden on person living with HIV

• We are slowly seeing the beneficial impact of TasP on HIV criminalisation policy; PrEP may also have impact community disclosure norms (reducing fear)

• PrEP allows for responsibility for HIV prevention to be controlled by the HIV-negative person

• PrEP as a ‘bridge’ to TasP? (Partners Demonstration Project)

PrEP and human, sexual and reproductive health and rights

• Procreation or pleasure• Right to healthy, satisfying sex lives• Right to have a family• Ensure that, like TasP, public health

benefits of PrEP do not “circumvent respect for individual autonomy in decision making about personal health”

• GNP+ New study on PrEP offers hope but a rights-based approach must be central. February 2015. Available at: http://www.gnpplus.net/resources/new-study-prep-offers-hope-rights-based-approach-must-central/

PrEP and stigma

• People living with HIV, and key populations not living with HIV experience stigma, especially in healthcare settings

• In addition, people taking PrEP can experience stigma: mistakenly thought to be living with HIV, and/or ‘slut shaming’

• But PrEP can also reduce stigma within communities

Excerpt from THE PROUD STUDY: Voices of the Participants. Available at: http://vimeo.com/mrcctu

• Key populations, half living with HIV• Low PrEP awareness• Divided opinions on benefits and risks

– Concerns over side-effects, effectiveness, STIs, risk compensation, stigma, ‘black market’ commodity

– Appreciation of additional prevention tool, stigma reduction

• Who gets priority? Everyone should be prioritised!

GNP+ What do key populations in South Africa think about PrEP and treatment as prevention? Understanding the Needs of Key Populations in the Context of Treatment as Prevention Approaches (Working Title), unpublished draft, March 2015.

GNP+ research among KPs in South Africa (2014)

HIV Positive People Diagnosed On ART Viral Suppression <1000 (ITT)*

0%

20%

40%

60%

80%

100%

53%

41%32%*

36.9million

19.8million 15.0

million 11.6*million

Global Estimates (2014-15) vs the Gap to reach 90-90-90 Targets

Ref: On ART = March 2015. How Aids Changed Everything. Fact Sheet. UNAIDS 2015. MDG 6: 15 YEARS, 15 LESSONS OF HOPE FROM THE AIDS RESPONSE July 2015. * Average viral suppression% Intention to Treat LMIC rate from a Systematic Review by McMahon J. et al. Viral suppression after 12 months of antiretroviral therapy in low-and middle-income countries: a systematic review." Bulletin of the World Health Organization 91.5 (2013): 377-385.

Breakpoint 1:13.4 million Undiagnosed Breakpoint 2:

14.9 million not treated

Breakpoint 3: 15.3 millionNot Virally Supressed

GNP+ Partners: evolving policy positions

PrEP for MSM Cannot Wait (July 2015) The Leading Global Network on MSM & HIV (MSMGF) Calls for Communities of Men Who Have Sex With Men Worldwide to Rally Behind Sexual Health Strategies

NSWP Publishes Global Consultation on PrEP and Early Treatment as Prevention Strategy: Experiences and Perspectives from the Sex Worker Community (July 2014)

PrEP must not come to eclipse

other essential harm reduction

interventions (March 2015)

Final thoughts• Meaningful engagement of people living with HIV and key

populations in effectiveness (for PUD) and implementation research for other key populations

• Scale-up community education on PrEP alongside other HIV prevention methods allowing access to accurate knowledge and information

• HIV prevention, treatment and key population advocates should work together towards common goals of:– Increased resources and reduced costs allowing for universal

access to testing, prevention, treatment, care and support– Reduced barriers to universal access, including laws and policies

that criminalise, control and punish.– Reduced stigma and discrimination in healthcare and community

settings– Holistic approach to HIV prevention, including scaling up existing

HIV prevention and harm reduction tools, as well as economic, social and emotional support.