They Thought This HIV Strategy Couldn't Work. But It Did

published on June 24, 2019 in npr

In high-income countries like the U.S., the standard of care for people infected with HIV is to provide antiretroviral pills when the virus is found, even when there are no symptoms of AIDS. The strategy staves off the disease and has a second — big — benefit. It has been shown to prevent the spread of HIV in sexual encounters. It's called "treatment as prevention" (TasP in medical jargon), or "test and treat."

But in low-income countries, "test and treat" is not the typical approach to prevention. There has been no research to support it.

So 10 years ago, researchers began planning a massive study of treatment as prevention in South Africa and Zambia. The team came from the London School of Hygiene and Tropical Medicine, Imperial College and from several other institutions in the U.S., Zambia and South Africa.

When they started, they said, there was some doubt in the AIDS research community about whether the effort would be successful. "People didn't think we could provide antiretroviral therapy in sub-Saharan Africa at all," says study co-leader Richard Hayes of the London School of Hygiene and Tropical Medicine. "There was a lot of skepticism."

Helen Ayles, from the same institution and a Zambian research organization called Zambart, hit the same resistance. "People said you'll never get communities to test, and you'll never get communities to want to start treatment early and if you do they'll never stay on the treatment." That attitude sprang partly from past struggles to get people to follow a regimen of daily drugs, in both developed and developing countries — and from local mistrust when foreigners arrive in low-income countries to carry out a health mission.

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They Thought This HIV Strategy Couldn't Work. But It Did

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