There is a new community consensus statement on treatment as prevention at https://tinyurl.com/jw3sjjk. You can download it easily and there are other materials at http://www.hivt4p.org/.

They statement raises a few issues that need to be underlined.

Treatment has been proven to prevent transmission through penile/vaginal sex in serodiscordant couples. In part of South Africa there appears to be a plateau effect when 40% of the people who need treatment are on it. Do not trust anyone who tells you that a 1% increase in treatment access leads to a 1% decrease in incidence. Consensus is that this is 'too good to be true'.

Treatment has not yet been proven to prevent transmission through anal sex. Studies may inform us soon.

We do not have sound evidence that treatment reduces the chances of infection through the use of shared injecting equipment. People who tell us to look at British Columbia do not mention that HIV prevention among people who inject drugs there is highly developed there so we cannot determine if treatment had a role in the slowly decreasing incidence. It may be quite a while before there is evidence that treatment works or doesn't work as prevention among people who inject drugs.

Antiretroviral treatment does not have an impact on the incidence of other sexually transmitted infections.

The consensus statement opposes any public health measures that are based on compulsory HIV testing or treatment. This is a challenge for Indonesia where compulsory HIV testing of sex workers is extremely common and among some populations in Myanmar where mandatory HIV testing takes place.

There is little hype and rant in this consensus statement. This makes it useful.

Jamie