Communities vital to delivering on the promise of WHO's new global HIV treatment guidelines

by International HIV/AIDS Alliance | @theaidsalliance | International HIV/AIDS Alliance - UK
Sunday, 30 June 2013 10:40 GMT

* Any views expressed in this article are those of the author and not of Thomson Reuters Foundation.

The Global Network of People Living with HIV (GNP+), the International HIV/AIDS Alliance (the Alliance), and STOP AIDS NOW!, today welcomed the World Health Organisation’s (WHO’s) new guidelines on the use of antiretroviral therapy (ART) for the treatment and prevention of HIV and called on governments, multilateral and bilateral agencies, and donors to ensure that communities are meaningfully engaged as countries implement these guidelines.

The WHO guidelines were launched at the 7th International AIDS Society conference on HIV Pathogenesis Treatment and Prevention taking place in Kuala Lumpur this week.

The new guidelines recommend that people living with HIV can start ART with a CD4 count of 500 cells/mm3 or less compared with a CD4 count of 350 cells/mm3 or less previously (2010 WHO ART Guidelines). Starting treatment earlier has shown to slow clinical progression, reduce the chance of life-threatening conditions such as tuberculosis (TB), and has the added benefit of reducing the risk of HIV transmission. The guidelines also recommend offering treatment regardless of CD4 count (i.e. immediate treatment after HIV diagnosis) to pregnant women, people living with TB or Hepatitis B, children under five years old, and people in relationships where one partner is living with HIV and the other is not.

The ownership, involvement and action of people living with HIV and their communities has significantly contributed to the increase in access to ART over the past decade. To ensure continued improvements in health for all, the WHO and health ministries must partner with communities to create an enabling political and legal environment for communities to ensure that individual human rights are protected, for instance by integrating and monitoring human rights aspects of the new guidelines to protect the health and rights of people living with HIV and other groups most at risk of the epidemic.

The guidelines recognise the constraints of health systems to deliver the optimal standard of care in resource poor settings and gaps remain in treatment coverage. That is why governments and donors must ensure strategic investments that support and scale-up effective community-based interventions – such as peer outreach workers, community-based testing, treatment literacy projects, community advocacy - that improve people’s ability to know their HIV status, and to access quality treatment and care that they need to stay healthy.

Last year, GNP+ and the Alliance, in collaboration with WHO, conducted a community consultation to inform the revised guidelines and help countries to make the best strategic decisions on the use of antiretrovirals. Throughout the consultation, community respondents emphasised the critical need for meaningful community engagement at all levels once countries begin adapting and implementing the 2013 guidelines.

To support communities to position themselves in discussions on the use of treatment for both health and prevention, GNP+, the Alliance, and SAN! are collaborating with partners to develop a “Community Guide” for use by networks, community-based organisations, and other civil society supporting community action on HIV. The Guide will be launched later on this year.