Good Health and Moral Responsibility: Key Concepts Underlying the Interpretation of Treatment as Prevention in South Africa and Zambia Before Rolling Out Universal HIV Testing and Treatment.
Gauging community responses to the WHO 2015 recommendation to provide antiretroviral treatment (ART) to all people living with HIV (PLHIV) is critical. There is limited qualitative evidence on the acceptability of this Universal Test and Treat (UTT) strategy or community understanding of the impact of ART on reducing HIV transmission, promoted as Treatment as Prevention (TasP). This article explores early understanding of UTT and TasP in 21 urban communities in South Africa and Zambia in 2013 before a community randomized trial of combination prevention-HPTN 071 (PopART). It draws on participatory research conducted in each community, which carried out group discussions and interviews with 1202 respondents and 203 structured observations. Participants were largely unfamiliar with the concepts of UTT and TasP. They were concerned about an accompanying de-emphasis on sexual behavior change. Treatment and prevention seemed, at first glance, to be experienced separately. With the exception of the prevention of mother-to-child transmission, prevention seldom came into discussions about ART. This was partly because this science had not yet been explained to many and also because it was not an easy fit. Contemplating the link between treatment and prevention, participants emphasized both PLHIV taking care of themselves through good health and preventing disease progression and the moral responsibility of PLHIV to prevent HIV transmission. To avoid igniting moralizing and blaming when introducing UTT and TasP, we should capitalize on the "taking care of yourself" legacy while boosting public responsibility through broad antistigma education and patient empowerment efforts.
1 Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine , London, United Kingdom .|2 Zambia AIDS-related Tuberculosis Project (Zambart), School of Medicine, Ridgeway Campus, University of Zambia , Lusaka, Zambia .
Virginia
V
Bond
3 Desmond Tutu TB Centre, Department of Paediatrics and Child Health, University of Stellenbosch , Tygerberg Campus, P.O. Box 241, Cape Town, South Africa .
Graeme
G
Hoddinott
3 Desmond Tutu TB Centre, Department of Paediatrics and Child Health, University of Stellenbosch , Tygerberg Campus, P.O. Box 241, Cape Town, South Africa .
Lario
L
Viljoen
2 Zambia AIDS-related Tuberculosis Project (Zambart), School of Medicine, Ridgeway Campus, University of Zambia , Lusaka, Zambia .
Melvin
M
Simuyaba
2 Zambia AIDS-related Tuberculosis Project (Zambart), School of Medicine, Ridgeway Campus, University of Zambia , Lusaka, Zambia .
Maurice
M
Musheke
1 Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine , London, United Kingdom .|4 MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda .
Janet
J
Seeley
D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D055812:Community-Based Participatory Research; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control*; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008403:Mass Screening; D009014:Morals; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012725:Sexual Behavior; D057545:Social Stigma; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D015024:Zambia / Q000453:epidemiology
D044966:Anti-Retroviral Agents