HIV Prevention and Transmission
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Despite substantial advances in the treatment of human immunodeficiency virusHIV/AIDS infection, the estimated number of annual new HIV infections in the United States has remained at 40,000 for over 10 years. HIV prevention in this country has largely focused on persons who are not HIV infected, to help them avoid becoming infected. But, further reduction of transmission of HIV will require using some new strategies, including more emphasis on stoping transmission of HIV. People who are infected with HIV and are aware tend to reduce risky behaviors that might transmit HIV to others. Nonetheless, recent reports suggest that such behavioral changes often are not maintained and that a substantial number of HIV-infected persons continue to engage in behaviors that place others at risk for HIV infection.
Reversion to risky sexual behavior might be as vital in HIV transmission as failure to adopt safer sexual behavior immediately after receiving a diagnosis of HIV. Unprotected anal sex seems to be happening more often in some urban centers, especially amoung young men who have sex with other men. Viral and bacterial STDs in HIV infected patients receiving care has been noticed more frequently, indicating ongoing risky behaviors. Despite the decline in syphilis infection rate in the general U.S. population, sustained outbreaks of syphilis among MSM, many of whom are HIV infected, continue to occur in some areas; rates of gonorrhea and chlamydial infection have also risen for this population. Rising STD rates among MSM indicate increased potential for HIV transmission, both because these rates suggest ongoing risky behavior and because STDs have a synergistic effect on HIV infectivity and susceptibility. Studies suggest that optimism about the effectiveness of highly active antiretroviral therapy (HAART) for HIV may be contributing to relaxed attitudes toward safer sex practices and increased sexual risk-taking by some HIV-infected persons.
Drug use still continues to play a huge role in the HIV pandemic; 28% of HIV/AIDS cases in adults and adolescents with known HIV risk category report to the CDC in 2000 were associated with needle drug use. In some large drug-using communities, HIV seroincidence and seroprevalence among injection drug users (IDUs) have declined in recent years. This decline has been attributed to several factors, including increased use of sterile injection equipment, declines in needle-sharing, shifts from injection to noninjection methods of using drugs, and cessation of drug use. But, injection-drug use among young adult heroin users has increased substantially in some areas a reminder that, as with sexual behaviors, changes to less risky behaviors may be hard to sustain.
Doctors and Clinicians caring for HIV-infected persons can help play a key role in help their patients reduce their risk factors. Clinicians can greatly affect patients’ risks for transmission of HIV to others by performing a brief screening for HIV transmission risk behaviors; communicating prevention messages; discussing sexual and drug-use behavior; positively reinforcing changes to safer behavior; referring patients for such services as substance abuse treatment; facilitating partner notification, counseling, and testing; and identifying and treating other STDs. These measures may also decrease patients’ risks of acquiring other STDs and bloodborne infections (e.g., hepatitis). Managed care plans can play an vital role in HIV prevention by incorporating these recommendations into their practice guidelines, educating their providers and enrollees, and providing condoms and educational materials. In the context of care, prevention services might be delivered in clinic or office environments or through referral to community-based programs. Some clinicians have expressed concern that reimbursement is often not provided for prevention services and note that improving reimbursement for such services might enhance the adoption and implementation of these guidelines.
Tags: AIDS, HIV, HIV prevention, HIV transmission
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