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A collection of HIV advocacy groups
has lambasted the recent Centers for Disease Control and Prevention–sponsored
trial that found a 49 percent reduction in risk among Thai injection drug users
(IDUs) taking an antiretroviral (ARV) to prevent HIV infection. This practice is known as pre-exposure
prophylaxis, or PrEP, and until this trial IDUs represented the last major risk
group to lack proof that PrEP could help curb the spread of HIV among them. In
a scathing release, the Thai Drug Users Network (TDN), the Thai AIDS Treatment
Action Group (TTAG) and Treatment Action Group (TAG) claimed the study was
conducted unethically, that it cannot effectively differentiate whether the
apparent risk reduction affected transmission routes through needles or through
sex, and that its faulty design prevents applying the findings to real-world
settings.
TDN, TTAG and TAG say that, during
the study’s planning process and its initiation, the study’s organizers
willfully ignored the expressed concerns of community stakeholders in Thailand,
including TDN, TTAG and the Thai National Network of People Living With HIV
(TNP+). These groups feel their demands for needle exchange programs to curb
HIV’s spread went unheard, as did their worries that the clinic staff
administering methadone to the drug users were also recruiting for the trial,
possibly causing visitors to the clinic to feel coerced. The groups also
complained that Thai community advocacy organizations were not given a place in
the community relations for the study.
What’s more, the groups claim the
trial failed to create a model for a real-world scenario because participants
were reimbursed financially for participation and because over 85 percent
received their ARV doses under observation.
In the release, Paisan Suwannawong,
executive director of TTAG and cofounder of TDN, said, “While TTAG is glad for
any evidence of reduced HIV transmission among people who inject drugs, this
trial failed to promote basic ethical practices and patently ignored community
concerns. In our opinion, the trial serves as a ‘worst practice’ example of
community engagement, failing to ensure participant access to a comprehensive
prevention package in a placebo trial, and ignoring other issues we tried to
raise to researchers at the outset.”
The advocacy groups also claim that
the trial cannot effectively differentiate between whether tenofovir, the drug
used in PrEP, prevented HIV transmission through needles or sex. They note
that, during the first three years of the trial, when needle use was the
highest, PrEP demonstrated no efficacy among the participants. Only in the last
four years of the trial, during which the number of participants declined and
the use of needles and the sharing of needles also dropped to “very low
levels,” was there a significant difference in HIV transmission rates between
the arms of the study.
To read the release, visit: http://www.treatmentactiongroup.org/hiv/Bangkok-prep-statement
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus.
To learn more about The Friends of
AIDS Foundation, please visit: http://www.friendsofaids.org.
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