HIV transmission is influenced by myriad individual, community, and societal factors. Thus, like prevention efforts for people without HIV, prevention efforts for people with HIV must be deployed at multiple levels (DiClemente et al, 2002). Over the past decade, an increasing number of individual and small group-level behavioral interventions have been shown to reduce HIV risk behaviors among people with HIV. (Kalichman, 2005). In particular:
- Several interventions that targeted men and/or women with HIV have improved their consistency of condom use, increased their perceptions of the advantages of condom use, and increased their confidence that they can use condoms consistently and correctly (Fogarty et al, 2001; Kalichman et al, 2001; Wingood et al, 2004)
- Several interventions for injection drug users with HIV have reduced their instances of needlesharing and unprotected sex (Margolin, Avants, Warburton, Hawkins, & Shi, 2003; Sterk, Theall, Elifson, & Kidder, 2003)
- Some social support and mental health counseling programs have reduced the number of HIV-positive men’s sexual partners (Coates, McKusick, Kuno, & Stites, 1989) and unsafe sexual acts (Kelly et al, 1993)
- A number of brief safer-sex counseling interventions have decreased the number of unprotected sexual acts among people with HIV, increased consistent condom use, and increased sexual abstinence (DiScenza, Nies, & Jordan, 1996; Padian, O’Brien, Chang, Glass, & Francis, 1993; Patterson & Semple, 2003; Patterson, Shaw, & Semple, 2003)
Prevention strategies for people with HIV focus on improving treatment and care for HIV- and AIDS-associated opportunistic infections, mobilizing communities to help reduce risk factors for HIV transmission, and changing policies that affect HIV-positive persons’ access to and use of prevention and treatment services (International HIV/AIDS Alliance, 2003).
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Individual-level behavioral strategies
Individual-level intervention strategies include voluntary counseling and testing for persons whose HIV status is unknown and post-test and ongoing counseling for people with HIV. Counseling efforts are designed to build the knowledge, skills, self-efficacy, and motivation needed to reduce or eliminate risky behaviors that can lead to HIV transmission. According to the International HIV/AIDS Alliance (2003), these strategies also may:
- Encourage beneficial disclosure, which involves the voluntary and often confidential disclosure of HIV-positive people’s serostatus to other people and organizations, so that the person with HIV will feel comfortable accessing HIV services. Beneficial disclosure also reduces the secrecy and stigma surrounding HIV/AIDS
- Encourage ethical partner notification, which involves the voluntary and often confidential notification of HIV-positive people’s sexual and drug-use partners, so that they will get tested and take precautions
Clinics are a key setting for such interventions, as people with HIV need frequent medical care to monitor antiretroviral effects and to treat opportunistic infections as HIV disease progresses. A study of 839 men and women with HIV at six public HIV clinics in California found that 50% had never discussed disclosure with a provider at their clinic, and 29% had never spoken with a provider at their clinic about safer sex (Marks et al, 2002). Thus, training clinic staff to deliver individual-level prevention interventions effectively should be a prevention priority.
Provider safer-sex counseling for HIV-positive patients (Richardson et al, 2004).
A multiagency collaboration led by Dr. Jean Richardson of the University of California Keck School of Medicine developed and implemented a brief intervention in which medical providers provided counseling and written information to patients with HIV. This brief intervention successfully reduced unprotected anal or vaginal intercourse among participants with two or more partners. First, clinic staff was trained in the background and rationale for the intervention, behavioral changes theories, communications skill building, and how to conduct a brief counseling session and make appropriate referrals.
Once the intervention was initiated, providers counseled each patient with HIV for 3-5 minutes, at each patient visit, about the patient-provider team approach to helping patients stay healthy, safer-sex goals, and risk-reduction behaviors. Providers also gave patients written materials that supported the intervention messages. The intervention counseling and written materials emphasized the negative consequences of unsafe sex for oneself and others.
Improved treatment and care
Improving treatment of and healthcare for people with HIV may include making available voluntary counseling and testing programs, integrating behavioral prevention counseling with HIV/AIDS treatment in clinical settings, and providing antiretroviral treatment as prevention for further transmission, including parent-to-child transmission. It also may involve reducing stigma and discrimination toward people with HIV in healthcare settings (International HIV/AIDS Alliance, 2003).
Community mobilization
People living with HIV are a part of broader communities and also influence those communities. They need the support of those communities and their broader environments to implement the risk reduction behaviors promoted by individual health promotion strategies. Community mobilization efforts may have a variety of positive prevention objectives. Some seek to involve communities in positive prevention by developing peer support groups for people with HIV. Others have trained people with HIV as peer outreach workers to increase the visibility of positives and reduce HIV/AIDS stigma (International HIV/AIDS Alliance, 2003). Other community-level interventions implement focused communication campaigns that raise awareness of the important role of people with HIV in reducing transmission.
HIV STOPS WITH ME: a social marketing campaign (HIV STOPS WITH ME, n.d.)
HIV STOPS WITH ME is a social marketing campaign that aims to reduce the stigma associated with HIV and to acknowledge the powerful role that people with HIV have in ending the epidemic. The campaign deals directly with sex and condom use, while raising themes of responsibility, communication, and disclosure of status. Each participating city (Boston, Buffalo, Los Angeles, Long Beach, New York, Portland, San Francisco, and Seattle) has its own Web site and several spokespeople who reflect the local demographic makeup. Spokespersons tell their own stories on the Web site and engage in online dialogue with other members of the community. The Web site also contains articles, resource lists, and an events calendar. HIV STOPS WITH ME further promotes its messages via billboards, print ads, posters in bars and clubs, outreach postcards, and television commercials.
In 2003 and 2005, HIV STOPS WITH ME won a People’s Voice Webby award for Best Healthcare Web site by the International Academy of Digital Arts.
Advocacy and policy change
The success of positive prevention efforts depends crucially on laws and policies, such as those concerning HIV/AIDS-related prevention and treatment funding; informed consent and confidentiality laws for HIV testing; and restrictions on school-based sexuality education curricula. Advocacy and policy change strategies involve people with HIV in the development of HIV-related policies and programs, including those that target people with HIV for prevention efforts, address stigma and discrimination against those who are positive, and increase access to treatment among all people with HIV (International HIV/AIDS Alliance, 2003).
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