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This post was published on 05/02/08 in Ideology and HIV, Pisani's picks, Science.

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  1. Comment by Chris Green, 06/02/08, 05:42:

    This has been the topic of some discussion on the Indonesian language AIDS mail lists. Since this is ‘public’, I feel comfortable to translate some of the comments.

    1. Frika Chia, APN+, in a discordant relationship:

    According to me, this is a very strong statement, that gives me “hope”.

    * Hope for my HIV-positive friends (with great implications for their ‘psychology’)

    * Emphasises that ART is effective as long as adherence is good – so that PLHIV are also responsible to adhere. And of course, the need for perfect drug supply.

    * Providing correct dosage – both patient and doctor are responsible to find out the correct dose, so that our friends who take ARVs can achieve and maintain undetectable viral loads.

    And up to now, what has been voiced by treatment activists that “Treament is Prevention” is very accurate. Increasingly we see that treatment is a part of prevention.

    2. Pandu Riono, epidemiologist.

    This is the evidence which must be considered:

    * Up to now, we have not been successful in eliminating HIV from the body of a person.

    * “Undetectable” HIV status can give the incorrect impression that HIV is no longer there, even no longer infectious. The views of those global-calibre scientists are wrong in interpreting the results of their research and in communicating the results.

    * “Undetectable” status is very temporary. After a period that cannot be determined, it can increase and become detectable.

    * The concept “treatment is prevention” only applies to special situations, for example PMTCT, or also temporary prevention of infection among discordant couples

    * It is important also that a person with HIV has a great chance to infect again and again if he/she does not reduce his/her risk behaviour.

    So, it is clear that this news according to me “dupes” the general public, because of incorrect interpretation of the results of the study.

    3. I have also received a private comment from a doctor who cares for young HIV-positive drug-users in recovery at a government drug rehab hospital near Jakarta. She says:

    “If this is confirmed, adherence and willingness to start ART will increase among the youth (because most of my patients are young and sexually active. It will help in discussion with my patients.”

    4. My personal comments:

    There are many young (often newly married) discordant couples in Indonesia. We frequently hear that the fear that the condom will break impacts greatly on their enjoyment of sex, and even their ability to achieve or maintain an erection, This news will greatly help.

    Further, most of these couples want to have kids. But sperm washing is hardly a feasible option for most where the male partner is positive. So they have to ‘take a risk’ when trying to get pregnant. This news will again allow them to do this with greater comfort, and conceive in joy rather than in fear.

    It is sad that UNAIDS, with as far as I know several PLHIV on its staff, is unable to appreciate these points and has followed such an insensitive line. Once again, this proves that their concern for, and understanding of, infected people is very limited…

    Chris

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