Americans publish guidelines on how to incorporate HIV prevention into HIV medical care

American public health officials have published a set of recommendations for the incorporation of HIV prevention initiatives into the routine medical care of HIV-positive individuals. The recommendations, which are summarised in the January 1^st edition of Clinical Infectious Diseases (now on-line), are the outcome of a collaboration between several US health organisations including the Center for Disease Control and Prevention and the National Institutes for Health.

There have been approximately 40,000 new HIV infections in the US every year for the past decade. The HIV prevention recommendations state that the only way to reduce the number of new infections is to develop new prevention initiatives which focus on the HIV risk behaviour of individuals already infected with HIV.

Some readers of the recommendations may detect evidence of political pressure: abstinence, the favoured HIV prevention intervention of the Bush intervention, is mentioned on several occasions as the only certain way of avoiding HIV transmission, sexually transmitted infections, or superinfection with another strain of HIV.

There are three main strands to the prevention package proposed by the US health officials, these are risk screening; behavioural interventions; and, partner notification.

Risk assessment

Patients who need more in-depth HIV prevention assessment and risk counselling can be identified, say the recommendations' authors, by a risk screening. Health care providers should ask their patients about their HIV risk behaviours, inquire if they have any symptoms suggestive of sexually transmitted infections (STIs), and offer STI testing.

Screening can be provided using a paper-and-pencil questionnaire, electronic media, or face-to-face interviews.

It is also recommended that women who are capable of having children should be questioned about the possibility of pregnancy and contraceptive methods.

Behavioural interventions

HIV clinics should display HIV prevention posters and have HIV prevention literature available "emphasizing the need for safer behaviour to protect [a patient’s] own health and that of their sex or needle-sharing partner" and should also highlight the need to disclose status to partners.

The authors go onto to say, "for sexual transmission, the only certain means for HIV-infected persons to prevent transmission to noninfected persons are sexual abstinence or sex only with a partner known already to be infected with HIV. However, restricting sex to partners of the same serostatus does not protect against the transmission of other STDS (sic) or the possibility of HIV superinfection unless" a condom is used. The recommendations also emphasise the need to counsel individuals taking HAART who have an undetectable viral load that they are still potentially infectious.

Patients with STIs or with other evidence of on-going risk-behaviour, should have a risk-reduction assessment which produces a risk reduction plan. This plan should address any obstacles to safer sex that an individual may be experiencing and patients should be referred to appropriate services, such as mental health teams, social services, or family planning clinics.

Partner notification

Reaching people who are unaware that they are HIV-positive is another priority highlighted by the recommendations' authors. Reaching such individuals will, say the authors, not only benefit their health, but also reduce the likelihood of them passing on HIV. Partner counselling and notification services should be employed. Notification services can confidentially notify a person’s past and current partners of their potential HIV exposure and encourage the partners to test for HIV. The authors however emphasise that notification is best undertaken by a trained professional, and that local laws and regulations to protect the patient’s confidentiality should be adhered to.