Combining approaches to HIV
ADRUG that has been shown to prevent HIV infection in a significant number of cases must be combined with behavioural approaches if the healthcare establishment is to succeed in reducing the spread of the virus, according to the American Psychological Association (APA).
“Exclusive reliance on a drug to prevent HIV or any sexually transmitted disease could actually result in a worse outcome if those at risk don’t understand how their own behaviour affects treatment,” said Dr Perry N. Halkitis, chair of APA’S Committee on Psychology and AIDS.
“We know that medical intervention depends on human behaviour. The fact that only 28% of Hiv-positive Americans in care achieve full viral suppression suggests very clearly that any medical intervention depends fully on behavioural, as well as social and political factors.”
A Food and Drug Administration panel recommended on May 10 that the FDA approve the drug Truvada to prevent HIV infection. APA has been monitoring the use of this, and other drugs, to prevent and treat HIV/AIDS.
While heartened by the addition of Truvada to the treatment mix, APA believes HIV prevention treatment must include both medical and behavioural approaches in order to succeed.
In February, APA passed a resolution emphasising the need for prevention research that incorporates strategies to deal with mental health, and substance abuse issues, behaviour change and adherence.
“Truvada by itself is not a magic bullet,” Dr Halkitis said. “The research to date shows that individuals taking the drug have had challenges adhering to the need to take it every day. It’s also important for anyone taking it as a preventive measure to continue to practise safe sex. These are all behaviours that need to be guided by multidisciplinary healthcare teams that include psychologists.”
APA president Dr Suzanne Bennett Johnson, agreed, warning that “If people taking the drug are not fully adherent and then contract HIV, that could lead to drug resistance.”
APA’S resolution cites research that shows a combination of behavioural and biomedical approaches work best to prevent HIV and other sexually transmitted infections. It references a 2010 study that tested adherence to Truvada within a group of men at high risk for infection, which found that 91% of those who later tested positive for HIV showed no detectable levels of the drug in their bloodstream, meaning they were not taking the drug as prescribed.
The resolution also points out that drugs “may be out of reach for certain populations (eg human trafficking victims, sex workers, people living in poverty, children, etc)”.
According to news reports, Truvada costs between US$11,000 and $14,000 (RM33,000 and RM42,000) per year, making it inaccessible to many. – Healthnewsdigest.com