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To the Editor: The meta-analytic review by Dr Crepaz and colleagues¹ provides reassurance that neither HAART use nor viral load were associated with increased sexual risk behavior. This is welcome news for those engaged in accelerating access to HIV treatment, since a key premise of scale-up efforts is that treatment and prevention are mutually reinforcing.² However, we are concerned that these conclusions are not based on data from resource-poor settings, where the prevalence of HIV/AIDS is highest. Sixteen of the 25 studies sampled populations from the United States; the other 9 were from industrialized countries. Furthermore, gay men were overrepresented in the analysis, accounting for the totality of 12 samples and the majority of 3 others; intravenous drug users accounted for the totality of 2 additional studies. The authors note that heterosexual respondents receiving HAART were significantly less likely to engage in unprotected sex than untreated respondents, but this . . . [Full Text of this Article]

Carla Makhlouf Obermeyer, DSc
obermeyerc@who.int

Rahul Rajkumar, BA
World Health Organization
Geneva, Switzerland

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