Postitive prevention: prevention strategies for people with HIV/AIDS (draft background paper)

This paper lays out in broad terms the rationale, context and options for prevention strategies for/by/with people with HIV.

It concentrates mainly on strategies that prevent onward transmission from people living with HIV through sex. It also includes interventions to prevent mother-to-child transmission (MTCT). The focus of the paper is on strategies that are specific to people with HIV, so mainstream prevention strategies such as condom promotion or STI diagnosis and treatment are not included here. The paper also does not address prevention through blood transfusions, injecting drug use, and other exposure to bodily fluids by caregivers or healthworkers.

The paper argues that the fact that 90% of people living with HIV in developing countries do not know their status and have no means of finding out is a severe hindrance to HIV/AIDS prevention. It therefore covers a continuum of strategies, from helping people find out their HIV sero-status by increasing access to voluntary counselling and testing (VCT), to enabling people who know they have HIV to reduce their risk of onward HIV transmission.

The paper argues the case for the implementation of HIV/STI prevention strategies with people with HIV. It outlines guidelines for good practice and dispels some common myths that exist around working with people with HIV, for example, that criminalising people with HIV who knowingly expose or transmit HIV will reduce HIV incidence. Both epidemiological and human rights perspectives are reflected, and authors discuss cases where public health objectives are not necessarily consistent with promoting and protecting the human rights of people living with HIV.

The paper recommends strategies for positive prevention, grouped under four headings:

• individually focused health promotion
• scaling-up, targeting and improving service and commodity delivery
• community mobilisation
• advocacy, policy change and community awareness

Each strategy is briefly described. Examples are given and the evidence for the effectiveness of each strategy in positive prevention is reviewed. A list of issues to consider when adapting each strategy is also included.