HIV treatment as prevention in Jamaica and Barbados: magic bullet or sustainable response?

J Int Assoc Provid AIDS Care. 2015 Jan-Feb;14(1):82-7. doi: 10.1177/2325957413511113. Epub 2013 Dec 30.

Abstract

This discursive article introduces HIV treatment as prevention (TasP) and identifies various models for its extrapolation to wider population levels. Drawing on HIV surveillance data for Jamaica and Barbados, the article identifies significant gaps in HIV response programming in relation to testing, antiretroviral treatment coverage, and treatment adherence, thereby highlighting the disparity between assumptions and prerequisites for TasP success. These gaps are attributable, in large part, to sociocultural impediments and structural barriers, severe resource constraints, declining political will, and the redefinition of HIV as a manageable, chronic health issue. Antiretroviral treatment and TasP can realize success only within a combination prevention frame that addresses structural factors, including stigma and discrimination, gender inequality and gender-based violence, social inequality, and poverty. The remedicalization of the response compromises outcomes and undermines the continued potential of HIV programming as an entry point for the promotion of sexual, health, and human rights.

Keywords: HIV infections; chemoprevention; health resources; political will; stigma and discrimination.

MeSH terms

  • Anti-Retroviral Agents / therapeutic use
  • Antiretroviral Therapy, Highly Active
  • Barbados / ethnology
  • Discrimination, Psychological
  • HIV Infections* / drug therapy
  • HIV Infections* / ethnology
  • HIV Infections* / prevention & control
  • Health Services Accessibility*
  • Humans
  • Jamaica / ethnology
  • Medication Adherence
  • Public Health
  • Social Stigma*
  • Socioeconomic Factors*

Substances

  • Anti-Retroviral Agents