Conference impressions Treatment as prevention •Many concerns about structural and cultural obstacles that need to be addressed in order to implement the prevention revolution Need to shift clinical perceptions about when to start treatment Need to shift community perceptions about toxicities of treatment and views on life- long treatment Paradox of ambitious HIV prevention targets and uncertain/reduced funding for community HIV organisations? •Division about ‘treatment as prevention’ Are we overcautious because of ‘hit early, hit hard’ approach and its problems? Do we fear the responses of govt and community if we say condoms are not the only way to go? •Many countries already embracing rapid testing, PrEP, and treatment for PLHIV >500CD4 •We don’t need to throw the baby out with the bathwater and forget what already works, but we need to respond to changing trends and information on treatment and lower risk of transmission
Conference impressions HIV testing •Need to shorten time between infection and diagnosis •How to increase testing frequency? •Need for rapid testing technologies and a simplification of conventional testing processes •Other testing technologies (home testing?) Research/evidence •Need for a strategic research response (related to new paradigm) •What do we call evidence? •What is sufficient evidence? PrEP •How to move forward with PrEP? (Demonstration projects currently in development) •Pricing options for ARVs for prevention (should be lower) •FDA approval may lead to informal use in Australia – how to respond to this?