HIV-positive people should be priority for prevention efforts

17 April 2003

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HIV-prevention efforts targeted at people already infected with the virus should be considered “a public health priority” according to an editorial by a group of US public health and HIV doctors in the April 2003 edition of the journal Sexually Transmitted Infections.

As only infected people can pass on HIV, the editorial maintains, “prevention efforts should be identified for those living with HIV”. The writers highlight three reasons why prevention efforts should be focused on people already diagnosed with HIV: evidence that at least a third of HIV-positive people have unprotected anal or vaginal sex; to improve the health of HIV-positive people by reducing the amount of sexually transmitted infections (STIs) they have; and, as STIs can make a person with HIV more infectious, reducing their prevalence in people with HIV will help reduce the spread of HIV itself.

The authors also highlight the risk of people with HIV being superinfected with HIV from unprotected sex.

Glossary

fatigue

Tiredness, often severe (exhaustion).

safer sex

Sex in which the risk of HIV and STI transmission is reduced or is minimal. Describing this as ‘safer’ rather than ‘safe’ sex reflects the fact that some safer sex practices do not completely eliminate transmission risks. In the past, ‘safer sex’ primarily referred to the use of condoms during penetrative sex, as well as being sexual in non-penetrative ways. Modern definitions should also include the use of PrEP and the HIV-positive partner having an undetectable viral load. However, some people do continue to use the term as a synonym for condom use.

Although the authors point to the “diverse array of biological, developmental, relational, social, psychological, cultural and environmental influences that underlie the adoption and maintenance of sexual risk or protective behaviour”, they highlight HAART as an “emergent” risk factor, leading to a “propensity” for HIV-positive people to have unprotected sex.

HIV prevention efforts should be enhanced, access to treatments expanded, and HIV prevention integrated into clinical management, the authors suggest. The social problems often faced by HIV-positive people are also highlighted, as potential barriers to prevention work, as are the “mosaic” of subgroups that the virus affects.

Criticising the antipathy towards HIV which has emerged in richer countries since the emergence of HAART, the authors call for urgent action, concluding “this is the time for a swift, determined and coordinated response; our passivity will only…perpetuate the HIV epidemic.”

Find out more in our About HIV pages

HIV prevention work in the UK targeted at HIV-positive gay men can be viewed on the websites of the Terrence Higgins Trust and GMFA. For studies on whether HAART “optimism” is associated with an increase in unprotected sex see the links below.