Who can benefit the most from positive prevention? Individuals with HIV who are sexually active or who use injection drugs can transmit the virus to others. Thus, they are logical targets of positive prevention efforts. Successful positive prevention efforts are comprehensive, combining prevention with HIV testing, treatment, and support.

HIV-positive and sexually active

Over 70% of people with HIV continue to be sexually active after they learn that they are infected (Office of AIDS, 2003). Although many engage in safer-sex practices, empirical evidence suggests that some people with HIV continue to have risky sex (Collins, Morin, Shriver, & Coates, 2000; De Cock, Mbori-Ngacha, & Marum, 2002; King-Spooner, 1999; Remien, Senterfitt, & Decarlo, 2000).

According to the Office of AIDS, people with HIV who have unprotected sex tend to:

Know less about HIV/AIDS, its transmission, and its effects on health
Believe that safer sex is less pleasurable than unsafe sex
Lack commitment to practicing safer sex
Lack confidence in their ability to practice safer sex
Perceive that they have little control over whether condoms are used
Have problems communicating with partners about safer sex
Perceive more barriers to condom use

Unprotected sex not only can transmit infection to uninfected partners; it also increases HIV-positive people's risk of getting STIs/STDs. STIs/STDs are serious health conditions that may accelerate HIV disease in people with HIV. They also can make HIV transmission to uninfected people more likely because STIs/STDs can increase the number of CD4+ cells near the genitals. Because HIV attaches to CD4+ cells, people with both STIs/STDs and HIV often have more HIV particles in their semen, vaginal secretions, anal mucus, and in the blood circulating near their genitals. They are also more likely to have open sores or easily injured skin, making direct transmission of HIV through blood more likely.

Even more serious than the threat of STIs/STDs is the threat of superinfection, which happens when a person with HIV becomes infected with a second strain of HIV. Increasingly, second infections are resistant to antiretroviral therapy (Collins et al, 2000; De Cock, et al, 2002). This is because many people with HIV take their antiretroviral drugs incorrectly, which allows the HIV to mutate into drug-resistant strains (International HIV/AIDS Alliance, 2002, 2003; Vernazza et al, 1999). Indeed, even recently infected people who have never taken antiretroviral therapy themselves sometimes already have drug-resistant strains of HIV, which they acquired from people who did not adhere to their antiretroviral regimens (CDC, 2003b). Moreover, research shows that people who have unprotected sex are less likely to take their antiretroviral drugs correctly (CDC, 2001, 2003b; Del Rio, 2003; International HIV/AIDS Alliance, 2002).

HIV+ and using injection drugs

Injection drug users with HIV are an especially important target for HIV prevention efforts, as they may engage in both drug use and sexual behaviors that can transmit HIV to others. These behaviors also can put themselves at risk of infection with another strain of HIV, as well as other diseases that can be transmitted through unprotected sex and use of nonsterile drug paraphernalia (Wilkinson et al, 2006).

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