2012 Conference

Is Treatment Enough Prevention?

UWW Cyber Digest

"Complexity science argues that some of the challenges in disease prevention and treatment are due to "the apparent compression of space and time." Many of our decision-making processes were "created with the implicit assumption of space and time lags … We used to have the luxury of a time lag between the discovery of an idea and the application into practice. This time lag is almost non-existent in many aspects of society today. In health care, medical research is reported on (often in 'sound bites' on the news). The public access to medical research has often created a push to put the ideas into application immediately." North American Primary Care Research Group, Resources 2009."

- Adapted from Zimmerman B, Lindberg C, Plsek P. (1998). Edgeware: Lessons from Complexity Science for Health Care Leaders. Dallas, Tx: VHA Inc.

Many researchers would argue that their findings do not translate quickly enough into policies and programs. However, in the case of "treatment as prevention" trials, we have seen the findings that effective treatment can reduce new infections in serodiscordant, heterosexual couples translate almost instantaneously into prevention messages such as "treatment is better than condoms" and "undetectable viral load means uninfectious." Public health researchers and practitioners are seeing an increase in unprotected sex – particularly among gay men and other MSM – and fear that the current discourse could reverse hard-won progress in HIV prevention.

What is the research telling us? What are the implications of these findings for populations and individuals at risk in Ontario? How should they shape our prevention messages? This international panel brings together clinical, epidemiological, basic and social science research to explore the relationship between biology and behavior.

William C. MillerWilliam C. Miller, M.D., Ph.D., MPH is an infectious disease specialist and epidemiologist at the University of North Carolina at Chapel Hill, where he is an Associate Professor of Medicine (School of Medicine) and Epidemiology (Gillings' School of Global Public Health.) At UNC, Dr. Miller is the Director of the Program in Health Care Epidemiology, Curriculum Director for the NC Translational and Clinical Science Institute, and Director of the STD/HIV Training Program.

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Susan KippaxSusan Kippax has a Ph.D. in Social Psychology and is a Fellow of the Academy of the Social Sciences of Australia. She is currently an Emeritus Professor in the Social Policy Research Centre, University of New South Wales, Sydney, having retired from the position of Director of the National Centre in HIV Social Research in 2007. Through her research, teaching and advisory roles, Professor Kippax has played a central role in framing Australia's response to HIV/AIDS and continues to play a key role in advancing social science in the field of HIV prevention.

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Patrick SullivanPatrick Sullivan, DVM, Ph.D. is an Associate Professor of Epidemiology at Emory University's Rollins School of Public Health, and the Co-Director of the Prevention Sciences Core at Emory's Center for AIDS Research (CFAR). Dr. Sullivan's research focuses on HIV among men who have sex with men, including behavioral research, interventions, and surveillance.

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Rupert KaulRupert Kaul, Ph.D. is a clinician-scientist based at the University of Toronto and has a clinical HIV practice at the Immunodeficiency Clinic, University Health Network. His research interests include: (1) how local factors in the genital tract, either immune factors or other co-infections, may increase HIV transmission; (2) the interactions between HIV and herpes simplex virus type 2; (3) the nature of immune responses that provide protection against HIV acquisition and/or progression; and (4) the effects of microbicides in clinical testing on the immunology of the genital tract.

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Barry AdamBarry Adam, Ph.D. is Professor of Sociology at the University of Windsor with a distinguished research and publication record devoted to issues of domination and empowerment. He is an author of books on The Survival of Domination, The Rise of a Gay and Lesbian Movement, Experiencing HIV, and The Global Emergence of Gay and Lesbian Politics. He is also Senior Scientist and Director of Prevention Research at the OHTN, and co-principal investigator with the CIHR Centre for REACH.

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Tony HughesTony Hughes, BSc, MSc, QSM has been involved in HIV/AIDS management on a full-time basis since November 1984. From 1990 to the present Tony has been Research Director of the New Zealand AIDS Foundation. His particular focus has been on drawing together knowledge from the biology and epidemiology of HIV transmission with knowledge about the sexual partnering and sexual behaviours of MSM in order to inform HIV prevention praxis at the coalface and support condom use for anal sex as the primary HIV and STI prevention strategy for gay men.

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