As condom use falls in many countries and HIV rates continue to rise, turning to treatment as prevention (TasP) may seem a natural progression in the fight against HIV. However, the New Zealand AIDS Foundation (NZAF) disagrees.
In 18 months up to December 2012, New Zealand saw a more than 39% decrease in new HIV diagnoses among gay and bisexual men — the country’s most at-risk group. They believe this downward trend is as a result of New Zealand's established condom culture and a compelling argument against the introduction of TasP.
NZAF Executive Director Shaun Robinson believes there are many problems with drug -based prevention; one of the keys being the messaging. "I worry some people will think popping a pill on a Friday night will give them a hall pass to have unprotected sex," he says.
If men are approached by guys saying it’s safe to bareback with them because they have an undetectable viral load then it’s likely some men will hear the message: "positive guys aren’t infectious anymore, I don’t need to use condoms".
While antiretroviral treatments do effectively reduce HIV viral loads, they don’t stop STIs which can go undetected and will increase HIV viral loads.
Syphilis and gonorrhoea are currently at epidemic levels amongst New Zealand’s gay and bisexual community.
The unravelling of an effective condom culture is a disturbing prospect for New Zealand. It would undoubtedly result in a spike in new HIV infections. It’s for this reason that the NZAF’s view on TasP is agreed with by the New Zealand HIV Forum of Clinical, Community and Government Stakeholders.
Although it is acknowledged that treatment as prevention for those with HIV might have a secondary impact on HIV prevention, drug-based approaches will never be an effective population strategy in New Zealand.
Says Robinson: "Why fix what’s not broken? Condoms have a proven 95% efficacy when used correctly and consistently. They remain the single most effective HIV prevention tool available."