Conflict of interest statement: No conflicts declared.
Separate Goals, Converging Priorities: On the Ethics of Treatment as Prevention
Version of Record online: 25 JUN 2013
© 2013 John Wiley & Sons Ltd. The Pan American Health Organization retains copyright and all other rights in the manuscript of this Separate Goals, Converging Priorities: On the Ethics of Treatment as Prevention as submitted for publication.
Developing World Bioethics
Special Issue: Anti-retrovirals for treatment and prevention – new ethical challenges
Volume 13, Issue 2, pages 57–62, August 2013
How to Cite
Ostmann, F. and Saenz, C. (2013), Separate Goals, Converging Priorities: On the Ethics of Treatment as Prevention. Developing World Bioethics, 13: 57–62. doi: 10.1111/dewb.12021
- Issue online: 18 JUL 2013
- Version of Record online: 25 JUN 2013
- treatment as prevention;
- antiretroviral therapy;
- priority setting
Recent evidence confirming that the administration of antiretroviral drugs (ARVs) to HIV-infected persons may effectively reduce their risk of transmission has revived the discussion about priority setting in the fight against HIV/AIDS. The fact that the very same drugs can be used both for treatment purposes and for preventive purposes (Treatment as Prevention) has been seen as paradigm-shifting and taken to spark a new controversy: In a context of scarce resources, should the allocation of ARVs be prioritized based on the goal of providing treatment, or on the goal of preventing the spread of the HIV epidemic?
Contributions to this discussion tend to assume that treatment and prevention constitute two divergent goals that entail conflicting priorities. We challenge that assumption on the basis of both conceptual and empirical examination. We argue that, as far as the provision of ARVs to HIV-infected persons is concerned, the goals of treatment and prevention do not entail conflicting priorities; to the contrary, they dictate converging strategies for the optimal allocation of ARVs. In light of the current evidence, the concept of Treatment as Prevention can indeed be seen as paradigm-shifting, yet in a novel way: Rather than extending the tension between the goals of treatment and prevention to the level of drug-allocation, it dissolves this tension by providing a rationale for a unified strategy for allocating ARVs.