The condom is the simplest and most effective method of HIV prevention. But condom use is not universal, and HIV researchers are still searching for additional ways to intervene in the virus' transmission. Now the National Institutes of Health (NIH) and Washington, D.C. are teaming up to test whether broadly applied antiretroviral treatment can be that new intervention. And their plan is radical in its scale—to aggressively treat every single HIV+ person..
The NIH researchers are working from a mathematical model suggesting that treating all persons infected with HIV with aggressive antiretroviral therapies has the potential to vastly reduce global disease rates—to one infection per 1,000 people by 2016. The model, says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, is based on the observation that, "When you follow couples—one who's infected, the other who's not—the probability of infection diminishes when the viral load is very low," as when drugs have been administered. So, the study intends to get infected individuals' viral loads down to levels where they cannot infect their sexual partners#8212;even in the absence of a condom. "The philosophy," Fauci says, "is if you test everybody, and treat everybody who has HIV, you could use treatment as prevention."
How, exactly, to test enough individuals to really blanket an area, and how then to persuade infected people to accept treatment, even if they are feeling perfectly well, are only a couple of the major obstacles this study faces. Still, for many Washingtonians, this study may be their first opportunity to seek treatment—researchers believe that one factor in infection rates is the lag time (about six months for at least half of people who test positive in D.C.) between test and first treatment. That sad statistic is about to change as the study is set to begin in the next couple of weeks—hopefully in time for December 1st, World AIDS Day. Aside from the district of Anacostia, which neighborhoods will be targeted is unknown—but if the strategy proves successful, it could be a new approach to fighting an intractable problem.