Ethical Allocation of Preexposure HIV Prophylaxis

Civil society-led movements transformed global AIDS action from deep skepticism about extending antiretroviral (ARV) treatment in low- and middle-income countries to a historic scaling up of treatment toward universal access. During its first phase (2003-2008), the US President's Emergency Plan for AIDS Relief (PEPFAR)--the largest national commitment to combat a single disease-supported treatment for more than 2 million people, care for more than 10 million people, and prevention of mother-to-child transmission in 16 million pregnancies. The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), a unique international financing institution, has committed $19.3 billion in 144 countries to support large-scale prevention, treatment, and care, with most resources devoted to AIDS treatment. Here, Gostin and Kim elaborate that policy makers will now have to consider implementing a new intervention, ie, preexposure prophylaxis (PrEP). Accordingly, recent studies suggest that PrEP could mean a shift of ARVs from treatment to prevention.