Differentiated Optimal ARV Adherence Messaging:
A concerted effort is needed to increase acceptance of ARV medication which in clinical parlance is adherence to the daily PrEP dosing regimen. This is core to HIV suppression which in turn means one cannot transmit HIV is the viral suppression has been found to be durably undetectable. But, for the population groups that are always on the marginal side, viral suppression may be hard to achieve. The political barriers that stand in the way have to be addressed. This will allow service providers to be consulted without fear of reprisals. This also builds a sense of security and accountability which addresses the needs many vulnerable population groups may face. The scale-up of PrEP in clinical settings should be concretized by a political regime which does not promote stigma and discrimination. It must be such that acts such as lynching, battering, eviction from homes, expulsions from workplaces are punished. When an atmosphere of genuine HIV eradication is built, can we then start seeing results where HIV incidence and prevalence are falling. Because it is such atmosphere that allows for people at high risk of HIV to access HIV transmission prevention prophylactics. It also addresses the psychosocial aspects of their needs such as stabler housing, job security, school retention and safety nets against the disabling effects of progressing HIV infection. Messaging to improve scaling of ARV should target the political gate keepers which in turn would spill out to other ranks. This means that it will a disaggregation of population groups which in turn will enable the needs to be addressed using a tailored approach. This is what the Global Fund is promoting. For instance, uptake of HIV and TB testing and treatment – as well as retention in treatment – is greater when programs include efforts to reduce stigma and discrimination in health care settings and in communities. Such programs may include training of health care workers in nondiscrimination and human rights literacy programs. To reach everyone in need with prevention, care and treatment, the Global Fund and partners are moving to a differentiated care approach – one that makes services more accessible and tailored to at-risk populations.