WHAT ARE
HIV+ PERSONS' HIV
PREVENTION NEEDS?
Unknown
why prevention
for HIV+ persons?
EVERY NEW HIV
INFECTION involves
an HIV+ person. The Centers for Disease
Control and Prevention (CDC)
estimate that there are 600,000-900,000
people living with HIV in the US. Yet
very few prevention interventions
have been directed to HIV+ women
and men. People who are HIV+ deserve
to have interventions to help
them stay safe and play an active role
in stopping the epidemic.
In the past few years, advances in
the treatment and care of HIV+ persons
have helped many people enjoy increased
health and longer life. For
many, this allows for a renewed interest
in sexual and for some, drug using
activity. More sexually active and drug
using HIV+ persons means the possibility
of more new infections.
why haven't
we done more of this?
In the past,
prevention efforts had
not been directed toward HIV+ persons
for fear of "pointing the finger"
or blaming HIV+ persons for the epidemic.
Although AIDS has become less
stigmatized in the US, in some communities
there is still serious stigma experienced
by HIV+ persons. AIDS activists
and HIV+ persons have also feared
laws criminalizing sexual risk behaviors
and further prosecution of injection
drug users. (IDUs).
Prevention efforts for HIV+ persons
have focused on protecting one's
own health from the possibility of reinfection
with untreatable strains of
HIV. Few efforts have addressed altruism-
the responsibility of HIV+ persons
to not transmit the virus to others and
the opportunity for HIV+ persons to
actively contribute to ending the epidemic.
Prevention efforts need to address
both issues: taking responsibility
for one's own health and the health
of one's partners, children, other family
members and community.
why would
someone infect another?
Most HIV+ persons
are concerned
about not infecting others and have
made efforts to prevent transmission.
Yet there has not been much support
for HIV+ persons to gain the necessary
skills and tools to adopt new, safer behaviors.
Couples where one partner is
HIV+ and the other is HIV negative
often wrestle with issues such as how
to maintain sexual satisfaction and
trust. For some couples, the risk of losing
commitment and intimacy in a relationship
is more threatening than the
risk of transmitting HIV.
A precondition of reducing your
risk is knowing you're HIV+ and getting
help. There are an estimated
200,000-250,000 Americans unaware
that they are infected with HIV. It is
imperative to help HIV+ persons get
tested before they unknowingly infect
others. Finding out HIV status can also
allow early access to life-prolonging
treatment and services.
disclosure
Incorrect assumptions
and denial
of responsibility between partners can
lead to risky behavior. Many HIV
negative persons are unaware of their
partners' status or risk behaviors and
may make assumptions that they are
not at risk for HIV because they are
married, in a relationship, their partner
looks healthy, or simply because
their partner did not ask to use a condom.
HIV+ persons may make the
same assumptions that their partner is
also HIV+ because the partner didn't
ask about serostatus or suggest using
condoms. Likewise, there may be a
difference of opinion on who's responsible
for keeping safe, the HIV positive
person, the HIV negative person,
or both.
Disclosure can be a way of beginning
a discussion about safer sex or
drug use. Yet disclosure of one's
serostatus is difficult for many HIV+
persons, especially women, who may
fear stigma, rejection or violence from
their partners.
Practicing safer sex with all partners
and always using clean needles is
one way of preventing transmission
without having to disclose status.
However, in many communities where
this is not the norm, simply using a
condom can disclose HIV+ status, even
without saying it.
HIV is a disease that is often mistakenly
associated with careless sexual
behavior. However, many HIV+ persons
become infected within a loving
relationship. In one study of HIV+ men
and women, 41% reported becoming
infected by a spouse, significant other,
or long-standing friend. Research has
shown that people are often more comfortable
disclosing and practicing safer
sex with partners outside of their main
relationship.
what are
barriers to prevention?
Often, the
same factors that led
someone to become infected are also
barriers to preventing transmission.
Many HIV+ persons face complex issues
that can affect their ability to engage
in safer sex or drug-using behaviors.
Depression, substance use and
abuse, history of violence and abuse
and sexual compulsivity are all issues
that may need to be addressed. Many
of these issues cannot be addressed in
a prevention program and may require
referral to longer-term counseling or
other social services.
Legal, political, and environmental
factors can be barriers to HIV prevention
among HIV+ persons. For example,
the lack of access to sterile syringes
and needle exchange programs,
as well as laws prohibiting possession
of syringes, hamper the ability of IDUs
to engage in safe behaviors. Fear of
arrest for carrying drug paraphernalia
has been associated with sharing syringes
and other injection supplies.
what's being
done?
In 1998, the
CDC funded five
Health Departments to create demonstration
projects providing primary
HIV prevention for HIV+ individuals.
California, Los Angeles, San Francisco,
Maryland, and Wisconsin have begun
a variety of programs that address a
wide audience including: HIV+
women, men of color who have sex
with men, IDUs, youth, female sex
and needle sharing partners of
IDUs, and incarcerated men and women.
Interventions include: HIV, STD
and TB counseling, testing and
treatment; referral and linkage to care;
prevention case management; HIV+
peer "buddies"; outreach via social
networks; mass media and internet
marketing; partner counseling and referral
services; skills building; and
community level forums and social
events.
campaign
AIDS Action
Committee in Boston,
MA, created an ad campaign that targets
HIV+ gay men with messages
aimed at opening discussion about
transmission and promoting responsibility.
Posters with messages such as
"Ask. Tell." "Let's stop new infections
now." and "If you're positive, think
about transmission." were placed over
urinals in gay bars and sex clubs. A
survey of men leaving the bathrooms
found that 70% could recall two or
more of the messages.
couples
Couples counseling
for sero-discordant
couples ( where one partner is
HIV+, the other HIV-) has proven highly
effective at reducing new HIV infections.
One program for heterosexual
women and men provided couples
counseling in combination with social
support. As a result, condom use increased
and no new HIV infections
were reported among the couples.
Couples counseling can help ease communication
and provide support for
both the HIV+ and HIV- partner in
straight and gay/lesbian relationships.
what needs
to be done?
HIV+ persons
are a unique population
in that they require both care and
prevention, which requires better coordination
between these two worlds.
