Barrow Geoffrey, Barrow Christine
Centre for HIV/AIDS Research, Education and Services (CHARES), Department of Medicine, University of the West Indies, Jamaica
Sir Arthur Lewis Institute of Social and Economic Studies (SALISES), University of the West Indies, Barbados.
J Int Assoc Provid AIDS Care. 2015 Jan-Feb;14(1):82-7. doi: 10.1177/2325957413511113. Epub 2013 Dec 30.
This discursive article introduces HIV treatment as prevention (TasP) and identifies various models for its extrapolation to wider population levels. Drawing on HIV surveillance data for Jamaica and Barbados, the article identifies significant gaps in HIV response programming in relation to testing, antiretroviral treatment coverage, and treatment adherence, thereby highlighting the disparity between assumptions and prerequisites for TasP success. These gaps are attributable, in large part, to sociocultural impediments and structural barriers, severe resource constraints, declining political will, and the redefinition of HIV as a manageable, chronic health issue. Antiretroviral treatment and TasP can realize success only within a combination prevention frame that addresses structural factors, including stigma and discrimination, gender inequality and gender-based violence, social inequality, and poverty. The remedicalization of the response compromises outcomes and undermines the continued potential of HIV programming as an entry point for the promotion of sexual, health, and human rights.
这篇论述性文章介绍了艾滋病治疗即预防（TasP），并确定了将其推广到更广泛人群层面的各种模式。文章借鉴牙买加和巴巴多斯的艾滋病监测数据，指出在艾滋病应对规划中，在检测、抗逆转录病毒治疗覆盖率和治疗依从性方面存在重大差距，从而凸显了TasP成功的假设与先决条件之间的差异。这些差距在很大程度上可归因于社会文化障碍和结构性壁垒、严重的资源限制、政治意愿的下降以及将艾滋病重新定义为一个可管理的慢性健康问题。抗逆转录病毒治疗和TasP只有在一个综合预防框架内才能取得成功，该框架要解决包括耻辱感和歧视、性别不平等和基于性别的暴力、社会不平等以及贫困等结构性因素。应对措施的重新医学化损害了成果，并削弱了艾滋病规划作为促进性健康、健康和人权切入点的持续潜力。
