The Network of Zambian People Living with HIV (NZP+) has commented on a recent statement made by Professor Paolo Marandola from the University of Pavia in Italy that HIV and AIDS would be stopped if all HIV positive people were put on treatment regardless of their CD4 count.
Professor Marandola’s comments relate to the preliminary results from HPTN052 clinical trial, conducted in May 2011, which suggested that ART taken by people living with HIV can reduce the risk of heterosexual transmission to an HIV negative partner by 96%.
Banda said using HIV treatment to prevent the transmission of the virus brings questions of finance to the forefront. Zambia should reduce its dependency on donors and increase local financing, particularly towards HIV and AIDS treatment she said.
Banda cautioned that, regardless of scientific findings, HIV testing should always be voluntary and confidential, be available anonymously and accompanied by full, complete and accurate information regarding the medical and legal consequences of testing HIV positive. She also warned that, when access to ART is limited as is the case of Zambia, those who require treatment based on individual clinical need in accordance with local guidelines must be prioritised. For instance, the World Health Organisation (WHO) ART guidelines recommend starting treatment when CD4 cells fall below 350.
Banda added that people living with HIV must be counselled on the health benefits they can expect from ART, the known short term effects of ART, the fact that not all side effects can currently be known if ART is comprised of relatively new drugs and that science is unclear whether treatment over CD4 350 delivers a net benefit or net harm.
People living with HIV must also be counselled on the potential progression of the virus in the event that they are not treated i.e. information specific to an individual’s clinical situation, including CD4 count, viral load and symptoms. Ms Banda said the counsellors should explain to someone in what circumstances ART could potentially reduce HIV sexual infectiousness and therefore provide greater confidence in one’s ability to protect their sexual partner and make informed choices. And crucially, decisions on when and if to start treatment must be made by the person living with HIV.
Support systems, including peer support must be put in place and funded to ensure that people living with HIV can access non-biased, non-judgemental, accurate and current information about treatment and prevention and can be supported in the decision about ART initiation or deferral, she said.
Finally she urged the government to ensure every health worker who prescribes ART has access to the latest information in a format and language readily understood by that person.