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Of guidelines, targets and resources: the documents that defined the 2014 International AIDS Conference
Gus Cairns, 2014-07-26 14:40:00

If there was a phrase that defined the 20th International AIDS Conference, one that surfaced in every few presentations and kept turning up in documents, it was “Key Affected Populations”.

The World Health Organization (WHO) actually released its new Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations on 11 July, nine days before the conference started.

The primary attention it garnered then was a couple of inaccurate reports in The Age (since corrected) and Time that the WHO was saying that “All men who have sex with men should take antiretroviral drugs”.

In fact, the WHO says something a lot more cautious and tentative, namely that the evidence suggests quite strongly that, for men who have sex with men (MSM), “PrEP is recommended as an additional HIV prevention choice within a comprehensive HIV prevention package”. (This also does not say that the ‘comprehensive HIV prevention package’ must include a recommendation only to use PrEP with condoms, as has also been alleged.)

The change from the previous guidelines is that they suggested that PrEP should only be offered as part of the ongoing research programme into this still new and hardly-used method of HIV prevention. Now the WHO is suggesting , quite radically, that the evidence is sufficient for the world to consider how it could move to enabling gay men to take PrEP. (It also adds that PrEP should be considered for the negative partner in couples of different HIV status, but this is not a new recommendation).

Brazilian HIV and STI health director Fabio Mesquita was in charge of the re-evaluation of the evidence for PrEP that found its way into the new guidelines. He told a press conference at Melbourne: “The question no longer is whether PrEP works, but whether we can make it available.”