Page 214 - HIV/AIDS Guidelines

Preventing Secondary Transmission of HIV (Last updated March 27, 2012;

last reviewed March 27, 2012)

Despite substantial advances in prevention and treatment of HIV infection in the United States, the rate of
new infections has remained stable. 1-2 Although earlier prevention interventions mainly were behavioral,
recent data demonstrate the strong impact of antiretroviral therapy (ART) on secondary HIV transmission.
The most effective strategy to stem the spread of HIV will probably be a combination of behavioral,
biological, and pharmacological interventions. 3

Prevention Counseling
Counseling and related behavioral interventions for those living with HIV infection can reduce behaviors
associated with secondary transmission of HIV. Each patient encounter offers the clinician an opportunity to
reinforce HIV prevention messages, but multiple studies show that prevention counseling is frequently
neglected in clinical practice. 4-5 Although delivering effective prevention interventions in a busy practice
setting may be challenging, clinicians should be aware that patients often look to their providers for
messages about HIV prevention. Multiple approaches to prevention counseling are available, including
formal guidance from the Centers for Disease Control and Prevention (CDC) for incorporating HIV
prevention into medical care settings. Such interventions have been demonstrated to be effective in changing
sexual risk behavior 6-8 and can reinforce self-directed behavior change early after diagnosis. 9
CDC has identified several prevention interventions for individuals infected with HIV that meet stringent
criteria for efficacy and scientific rigor (http://www.cdc.gov/hiv/topics/research/prs/index.htm). The
following three interventions have proven effective in treatment settings and can be delivered by providers as
brief messages during clinic visits:

• Partnership for Health (http://effectiveinterventions.org/en/Interventions/PfH.aspx),
• Options (http://www.cdc.gov/hiv/topics/research/prs/resources/factsheets/options.htm),
• Positive Choice (http://www.cdc.gov/hiv/topics/research/prs/resources/factsheets/positive-
choice.htm).

In addition, CDC’s “Prevention Is Care” campaign (http://www.actagainstaids.org/provider/pic/index.html)
helps providers (and members of a multidisciplinary care team) integrate simple methods to prevent
transmission by HIV-infected individuals into routine care. These prevention interventions are designed to
reduce the risk of secondary HIV transmission through sexual contact. The interventions are designed generally
for implementation at the community or group level, but some can be adapted and administered in clinical
settings by a multidisciplinary care team.

Need for Screening for High-Risk Behaviors
The primary care visit provides an opportunity to screen patients for ongoing high-risk drug and sexual
behaviors for transmitting HIV infection. Routine screening and symptom-directed testing for and treatment
10
of sexually transmitted diseases (STDs), as recommended by CDC, remain essential adjuncts to prevention
counseling. Genital ulcers may facilitate HIV transmission and STDs may increase HIV viral load in plasma
and genital secretions. 7, 11-13 They also provide objective evidence of unprotected sexual activity, which
should prompt prevention counseling.

The contribution of substance and alcohol use to HIV risk behaviors and transmission has been well
established in multiple populations; 14-18 therefore, effective counseling for injection and noninjection drug
users is essential to prevent HIV transmission. Identifying the substance(s) of use is important because HIV

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents L-1

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