Prevention with Positives

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Most prevention efforts have focused on HIV negative patients. However, despite these efforts, the incidence of HIV in the United States has remained fairly steady throughout the course of the epidemic at about 40,000 new infections per year. The public health community is now increasingly gearing its HIV prevention efforts on the HIV positive community. In 2003, the CDC released guidelines entitled “Incorporating HIV Prevention in the Medical Care of Persons Living with HIV” which can be found at:

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5212a1.htm

The CDC divides their recommendations into three parts:

screening for transmission behaviors and STDs
providing brief behavioral risk-reduction interventions and selected referral for high-risk patients
facilitating notification and counseling of sex and needle-sharing partners of infected persons

There is nothing groundbreaking in the CDC document but it reminds the clinician to avoid stigmatizing statements and to spend the time to ask specific questions regarding sexual and needle-using practices. Because the presence of STDs increases HIV transmission, a coordinated STD screening program reduces HIV transmission.

Oftentimes, time is the limiting factor when delivering prevention messages. The patient education coordinator, Kyle Davidson, or the prevention clinician at the Department of Public Health, Sylvan Lowens, can be useful resources to the clinician. Partner notification in King County is handled through the Public Health Department. If you have concerns regarding ongoing risk of HIV transmission and a patient not disclosing their HIV status to a partner Edith Allen of the Department of Public Health should be contacted at 744-4377.

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