HIV Prevention Knowledge Base
Combination Approaches: Positive Health, Dignity, and Prevention (PHDP)
Positive Health, Dignity, and Prevention: Technical Consultation Report
This report of a consultation on positive health, dignity, and prevention held in Tunisia in 2009 included participants from around the globe who developed an international consensus on the meaning of positive health, dignity, and prevention (PHDP) with participation by people living with HIV (PLWH) who worked with civil society, government agencies, international development agencies, UNAIDS co-sponsors, and donor agencies. They agreed that PHDP “requires a human rights approach based on legal protections and a policy environment free of stigma and discrimination for PLHIV” and that “programmes must promote holistic health and wellness, including access to HIV treatment.” The report concludes with recommendations for networks of PLWH, civil society, and public sector organizations and donors.
PEPFAR’s Meaningful Involvement of People Living with HIV/AIDS
This brief from the President’s Emergency Program for AIDS Relief (PEPFAR) highlights the importance of involving people living with HIV (PLWH) in program efforts and notes that PLWH are “vital contributors to the success of prevention efforts; important partners in health care delivery; sources of care and support for their communities; and effective advocates who can help build in-country capacity, local ownership, and accountability to promote sustainable efforts.”
PEPFAR’s Prevention for Positives
The President’s Emergency Program for AIDS Relief (PEPFAR) expanded from a focus on HIV-negative individuals to include interventions for people living with HIV (PLWH). Prevention efforts with PLWH include efforts to mitigate the spread of HIV to sex partners; injecting drug use partners; and infants born to HIV-infected mothers, as well as efforts to protect the health of infected individuals. The adoption of healthy living and reduction in risk behaviors among PLWH can lead to substantial improvements in the quality of life and a reduction in HIV transmission rates.
Positive Prevention by and for People Living with HIV
This discussion paper was prepared for the LIVING 2008 partnership summit, held in Canada in 2008. The paper calls for leadership by people living with HIV in linking prevention and treatment; working to end stigma and discrimination; and advocacy and policy changes to address social vulnerabilities of people who are living with HIV. The paper outlines a range of programmatic issues and interventions, such as clinical and biomedical issues (including antiretroviral therapy and the risk of re-infection); psychosocial and social determinants of health; community participation; and policy and advocacy.
Positive Prevention. LIVING 2008: The Positive Leadership Summit
This short statement from the Summit outlines the issues of living positively, including strong prevention elements. It includes messages and targets for advocacy to advance the issue with policy makers.
Essential Prevention and Care Interventions for Adults and Adolescents Living with HIV in Resource-limited Settings
To promote health and reduce transmission, this report puts forward a set of “essential” prevention and care services for adults and adolescents living with HIV. Descriptions of each service include country-specific considerations. Recommendations, which include psychosocial support, vaccination, family planning, and hygiene, among others, are scored for the strength of their scientific grounding.
HIV Prevention with HIV-Infected Persons Seen in Primary Care Settings
The journal AIDS and Behavior released this special supplemental issue focusing on prevention with people living with HIV. The articles summarize programmatic responses in the United States. While programs highlighted have not undergone outcome evaluation, the peer-reviewed articles summarize the intervention development experience, intervention content, and implementation experiences/lessons learned.
Changes in Sexual Behavior and Risk of HIV Transmission after Antiretroviral Therapy and Prevention Interventions in Rural Uganda
This study examines changes in risky sexual behavior among HIV-infected Ugandan adults following initiation of antiretroviral therapy (ART) and its effects on HIV transmission to stable partners. Other prevention measures were also provided, including voluntary counseling and testing for cohabitating partners and free condoms. Nearly 900 ART-naïve people living with HIV were evaluated at baseline and quarterly following initiation of ART. Six months after initiating ART, risky sexual behavior fell by 70 percent. Over 85 percent of risky sexual acts occurred within married couples. Estimated risk of HIV transmission from cohort members declined by 98 percent. The researchers conclude that ART combined with other risk-reduction measures reduces the risk of HIV transmission. However, they acknowledged that it would be difficult to distinguish whether all, or only some, of the interventions contributed to the reduction.
HIV Prevention for a Threatened Continent: Implementing Positive Prevention in Africa
This advocacy article urges strong emphasis on HIV prevention efforts; the authors point to the enormous human tragedy represented by more than 2.4 million deaths and 3.2 million incident HIV infections in sub-Saharan Africa in 2005. The authors emphasize the inadequacy of current HIV prevention efforts in sub-Saharan Africa and state that despite considerable expansion of antiretroviral therapy (ART) programs, prevention efforts have not kept pace. In low-income countries, investment in prevention may be cost-effective, since future care and treatment costs will be averted. New approaches and new resources might reinvigorate underfinanced HIV prevention efforts and avoid a widening gap between the numbers of individuals needing and receiving ART.
Group Intervention to Reduce HIV Transmission Risk Behavior among Persons Living With HIV-AIDS
Healthy Relationships, a small-group, skills-based behavioral intervention for men and women living with HIV, is comprised of five sessions delivered over two-and-a-half weeks. Although male and female groups are conducted separately, all sessions are facilitated by one male and one female, one of whom is an HIV-positive peer counselor. The intervention was developed and tested among people living with HIV in Atlanta, Georgia. At six-month follow-ups, participants showed significant reductions in the number of unprotected vaginal/anal sex acts with HIV-negative partners; overall and unprotected vaginal/anal sex acts; and had fewer non-HIV-positive partners than the comparison group. Participants were also more likely to use condoms for vaginal/anal sex and more likely to refuse unsafe sexual practices than comparison group participants.
Effect of Brief Safer-sex Counseling by Medical Providers to HIV-1 Seropositive Patients: A Multi-clinic Assessment
Partnership for Health (PfH) is a brief (3-5 minute), provider-delivered counseling program for individual men and women living with HIV in California, USA. The program is designed to improve patient-provider communication about safer sex, disclosure of serostatus, and HIV prevention. The model supports clinic staff “buy-in” and training. The intervention study found that patients who had two or more sex partners or at least one casual partner and who received consequences-framed messages were significantly less likely to engage in unprotected anal or vaginal sex. There was no change among those with only one partner or a main partner at baseline.
Prevention for Substance-Using HIV Positive Young People: Telephone and In-Person Delivery
Choosing Life: Empowerment, Actions, Results (CLEAR) is an intervention comprised of three modules that is delivered individually to youth living with HIV in two major U.S. cities. Modules address physical health and antiretroviral adherence; reduction of risky sexual and substance use behaviors; and condom use and safer sex negotiation skills. Study participants received either in-person intervention, telephone-delivered intervention, or served as waitlist controls. At 15-months, intervention participants reported significantly greater increases in the proportion of protected sex acts with all sex partners and HIV-negative partners than did control participants. Participants who received the in-person intervention reported significantly greater risk reduction behaviors at 15 months compared to participants who received the telephone-delivered intervention.
A Randomized Controlled Trial to Reduce HIV Transmission Risk Behaviors and Sexually Transmitted Diseases among Women Living with HIV: The WiLLOW Program
The Women Involved in Life Learning from Other Women (WiLLOW) intervention is a small group, skill-training for women living with HIV. Rooted in gender and power theory, the four, four-hour sessions delivered over four weeks focus on HIV awareness, safer sex communication skills, and relationship decision-making. The study was conducted among African-American women in Alabama and Georgia, USA. At 6- and 12-month follow-ups, women who participated in WiLLOW reported significantly fewer acts of unprotected vaginal sex and were significantly less likely to report never using condoms than women in the comparison group. Additionally, over 12 months, women in the WiLLOW intervention were significantly less likely to acquire new bacterial sexually transmitted infections than women in the comparison group.
Sexual Behavior of HIV Discordant Couples after HIV Counseling and Testing
The authors examine the sexual behavior of 963 serodiscordant couples in Lusaka, Zambia, following voluntary HIV counseling and testing (VCT) through self-reports and biomarkers. It was found that condom use was the primary method to reduce HIV transmission to the non-infected partner. Prior to VCT, less than 3 percent of couples reported using condoms. During follow-up in the year after VCT, 80 percent used condoms. Individuals who reported always using condoms, had a 39 to 70 percent decline in sexually transmitted infection rates, including HIV. However, under-reporting of unprotected sex was common. For example, couples who reported to always use a condom still had sperm detected in vaginal smears and pregnancy was common.
Incorporating HIV Prevention into the Medical Care of Persons Living with HIV: Recommendations of CDC, HRSA, NIH, and the HIV Medicine Association of the Infectious Diseases Society
This set of recommendations from the United States Centers for the Disease Control and Prevention proposes a role for medical providers in screening HIV-positive patients for sexual and drug-related risk behaviors; engaging them in risk-reduction; notifying and testing partners; and screening for and treating sexually transmitted infections. A table presents the relative risk of a spectrum of sexual behaviors. Patient scenarios are discussed, and tools are offered to guide screening and messaging. Ratings are given for the strength of the evidence underpinning each recommendation.
An Evaluation of the MoH/NGO Home Care Programme for People with HIV/AIDS in Cambodia
Home-based care services for people living with HIV (PLWH) can contribute to HIV prevention efforts. Home visitors can: promote safer sex; refer PLWH and partners for services related to HIV, sexually transmitted infections, and preventing mother-to-child transmission. They can also help to decrease stigma and discrimination by supporting community response and acceptance of PLWH. In this evaluation of the Khana Home Care Program for PLWH in Cambodia, nearly half of PLWH said home-care teams increased their comfort in disclosing their HIV status to others and nearly 30 percent of PLWH reported using condoms as a result of their increased knowledge about HIV.