Treatment as prevention could reduce HIV burden, strengthen community ownership of the HIV response, and complement HIV prevention approaches and other health interventions such as sexual and reproductive health. However, the generalisability of HPTN results to key populations, who so far have largely been left out of research on treatment as prevention, is limited. In addition, it may have negative impacts, for instance on individual rights, psychosocial well-being and criminalisation of HIV transmission.
In order to make treatment as prevention work for key populations, it should be implemented through a human rights based combination prevention approach, with a focus on behavioural and structural interventions, which are often insufficiently integrated in field trials. Community mobilisation is important in mobilising key populations to enable uptake of HIV testing and antiretroviral therapy and mitigate further medicalisation of the HIV response.