For the first 2 decades of the HIV/AIDS epidemic, HIV prevention interventions mostly encouraged uninfected people to adopt safer-sex and drug-using behaviors, so that they would not get HIV (Office of AIDS, 2003). People with HIV were not a focus of prevention efforts for several reasons. Among the public, there was reluctance to acknowledge that people with HIV have sex. There also was a perception that it was contradictory to try to prevent a disease among people who already had it. In addition, there was concern that such a focus would be perceived as blaming people with HIV for the epidemic. More recently, researchers, governments, and healthcare providers are recognizing that people with HIV need prevention interventions, too (Kelly & Kalichman, 2002). These secondary prevention interventions are sometimes called positive prevention. Positive prevention is important because:
- HIV is transmitted by people with HIV. From an epidemiological and public health perspective, people with HIV make up the most important group to address with HIV prevention strategies (DiClemente, Wingood, Del Rio, & Crosby, 2002; International HIV/AIDS Alliance, 2003). A change in the risk behavior of a person with HIV will, on average and in almost all affected populations, have a much bigger impact on the spread of the virus than the same behavioral change in a person without HIV (King-Spooner, 1999; Vernazza, Eron, Fiscus, & Cohen, 1999)
- Some people living with HIV continue to engage in risky behaviors. Following their diagnosis, many people with HIV use condoms more regularly and adopt other safer sex and drug use practices. Over time, however, many revert back to risky sex and drug use. Prevention interventions for positives may help people with HIV sustain healthy behavior changes (DiClemente et al, 2002; Wolitski, Janssen, Onorato, Purcell, & Crepaz, 2005)
- People with HIV have the right to live well with HIV. Living well with HIV includes having a healthy sex life. This means protecting people with HIV against superinfection (ie, reinfection with a different strain of HIV) and against new STIs/STDs (International HIV/AIDS Alliance, 2003; Wolitski et al, 2005)
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