Towards the Ethical implementation of Testing, treatment and HIV care in key populations: Investigating Community-based priorities in the Scale-up of Treatment as Prevention (TasP)

Globally, key populations including sex workers, transgender individuals and men who have sex with men are disproportionately impacted by the HIV epidemic. Despite bearing a disproportionate burden of the epidemic, these key populations continue to experience dismal access to HIV prevention, testing and treatment, highlighting an urgent need to close the gap in the HIV care cascade for these key populations. Treatment-as Prevention (TasP) strategies targeting key populations is increasingly being adopted globally to address existing inequities in the HIV care cascade, as evidenced by the UNAIDS' 90-90-90 targets. Although TasP is based on well-established scientific evidence demonstrating the capacity of HAART to reduce morbidity, mortality and onward HIV transmission at the population level, the rapid roll out of TasP has been met with significant caution and concern by the community, policy makers and human rights experts, given the wide range of potential ethical concerns. As such, community groups and academics alike have highlighted an urgent need to identify and evaluate ethical concerns regarding TasP and document the lived experiences of affected communities. Aligned with increasing calls by community groups globally for Community-Based Research (CBR) on the ethics of TasP, the proposed CBR project is designed to evaluate the ethical implications of targeted TasP strategies from the standpoint of affected communities. The proposed project builds on a number of successful networks with Community-Based Organizations, AIDS Service Organizations and university-based academics to guarantee true and successful collaborations, develop CBR capacity and leadership, and ensure effective KT and social action. The CBR approach proposed embraces the Greater Involvement of People living with HIV/AIDS principles and will contribute greatly to improving TasP policy and programming globally and result in a CBR agenda on ethics and TasP for future research applications.