Combined HIV Prevention and Treatment

Integration of Biomedical and Behavorial Approaches

Significant advances in biomedical HIV research have been made in the fight against HIV/AIDS over the past few years. An increasing body of research documents the benefits of early initiation of HIV treatment for HIV-infected adults and has accelerated the emergence of new biomedical HIV prevention options. Recently, an FDA Advisory Panel recommended approval of the antiretroviral drug Truvada for prevention of HIV transmission among adults. With the culmination of the science documenting the efficacy of biomedical options, many feel that biomedical approaches should be prioritized over behavioral methods. The debate over the relative value of biomedical versus behavioral approaches to HIV prevention has serious implications for policy and funding decisions at the federal level.

The Case for a Combined Approach

Psychology has contributed a great deal in the domestic and global fight against HIV/AIDS and should continue to play an important role in the future. In February 2012, the American Psychological Association passed a resolution entitled "Combination Biomedical and Behavioral Approaches to Optimize HIV Prevention." (PDF, 83KB) The resolution emphasizes the need for prevention research that incorporates strategies to address mental health and substance abuse issues, behavior change and adherence.

Evidence-based behavioral strategies have been proven effective in the prevention and treatment of HIV/AIDS and can greatly enhance the effectiveness and impact of existing interventions. Proven behavioral approaches, particularly when combined with biomedical strategies, have been found to: optimize the effectiveness of biomedical interventions; increase access to care; increase retention in care; increase treatment adherence; reduce overall cost of care; reduce the stigma associated with the disease; and address comorbid mental health and substance abuse issues (APA’s Resolution on Combination HIV/AIDS Prevention, 2012).

  • Research shows that biomedical approaches are optimized when combined with behavioral approaches.

  • Many recent biomedical research trials incorporated behavioral components into the study design. The best results were observed when the two approaches were combined.

  • Biomedical interventions are dependent upon behavioral factors related to medication adherence and treatment use.

  • Biomedical interventions show suboptimal results when not combined with behavioral approaches.

  • Not everyone has access to biomedical treatment. Financial barriers and other obstacles make costly biomedical treatment, including new HIV prevention technologies, inaccessible for some of the most vulnerable populations (e.g., those living in poverty, children, human trafficking victims, sex workers, etc.).

  • The long-term consequences and ethical issues related to everyday clinical use of biomedical interventions have yet to be adequately assessed.

  • Even with the emerging promise of biomedical HIV prevention interventions, behavioral approaches are needed more than ever to bolster medication adherence and treatment uptake, to document real-world decision-making processes associated with biomedical interventions, and to better understand potential unintended and/or undesired consequences of biomedical interventions.

APA Recommendations

Congress and the Executive Branch should continue to acknowledge the value of behavioral research and combination approaches to HIV prevention and treatment through:

  • Continued support for a robust HIV/AIDS behavioral prevention research agenda that includes operations research to optimize combination HIV prevention;

  • Continued focus on the integration of biomedical, behavioral and structural approaches through interdisciplinary research and implementation teams, and dissemination of effective strategies to prevent and treat HIV; and

  • Prioritization of combination strategies in the National HIV/AIDS Strategy implementation and through U.S. commitments to global AIDS programs.

 

For more information, please contact Leo Rennie, MPA, in the APA Public Interest Government Relations Office at (202) 682-5110.