The Importance of Prevention Efforts with HIV-Positive Individuals Receiving Clinical Care

[摘要]

THE AMERICAN PUBLIC HEALTH ASSOCIATION,

Recognizing that advances in HIV treatment have increased the number of persons living with HIV/AIDS and the critical need for and the importance of targeting prevention efforts to those who are HIV positive.¹

Recognizing that in 2001, the Institute of Medicine issued a report calling for enhanced HIV prevention efforts in the clinical setting as part of the standard of care for HIV- infected persons who receive medical care.²

Recognizing that while there are over 900,000 HIV-infected people in the United States, only 300,000 people are receiving regular HIV clinical care.³

Recognizing that with the October 2000 reauthorization of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, this legislation directed an increased focus on delivering care to an even larger proportion of persons living with HIV infection demonstrates an effort to increase the number of HIV-positive persons in care.⁴

Recognizing that the estimated risk of transmitting HIV to an uninfected person is strongly influenced by the amount of virus in serum and genital secretions.⁵

Recognizing that 60-90 percent of patients who received highly active antiretroviral therapy through clinical trials experienced a decrease in viral load to undetectable levels (HIV-1 RNA less than 500 copies/mL) and that transmission rates can be significantly decreased if viral loads in HIV-positive individuals are reduced through antiretroviral therapy.⁶

Recognizing that in recent years, sexual risk behaviors and STIs have increased among persons at risk for HIV, and that there is now ample evidence that unsafe sexual behaviors and STI’s are frequent among HIV seropositive persons.^7,8

Recognizing that successful HIV-transmission risk reduction can result from behavioral interventions tailored for HIV-positive men and women.⁹

Acknowledging that it is more common for health care providers to provide prevention counseling at the first clinical visit than in follow-up visits.¹⁰

Acknowledging that the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the Infectious Diseases Society of America are currently collaborating on prevention guidelines for clinicians with HIV-infected patients.¹¹

Recognizing that HIV infected persons are a unique population requiring both care and prevention services, requiring significant coordination between these two disciplines.

Therefore, as part of a comprehensive approach to HIV prevention, APHA:

1. Encourages the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the Infectious Disease Society of America to broadly disseminate their prevention guidelines for clinicians with HIV-infected patients; 
2. Urges the Centers for Medicare and Medicaid, the Centers for Disease Control and Prevention and the Health Resources and Services Administration to collaborate on HIV/AIDS prevention strategies and the integration of prevention and care funding and policies;
3. Urges increased funding for the development of HIV prevention demonstration projects as a component of sexually transmitted diseases/infections programs to provide onsite screening, treatment and related services in settings serving HIV-infected and at-risk individuals; and
4. Calls for an increase in funding for and the development of comprehensive approaches to prevention efforts targeting HIV infected persons including strategies to teach new, safer behaviors. 

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References

1. Centers for Disease Control and Prevention, HIV Prevention Strategic Plan Through 2005, January 2001.
2. Institute of Medicine (2001). No Time to Lose: Getting more from HIV Prevention. Monica S. Ruiz, Alicia R. Gable, Edward H. Kaplan, Michael A. Soto, Harvey V. Fineberg, & James Trussell, Editors.
3. Centers for Disease Control and Prevention, HIV and AIDS – United States, 1981–2000. Morbidity and Mortality Weekly Report, 2001:50(21), 429-444.
4. Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 (Public Law 101-381)
5. Ragni MV, Hawazin F, Kingsley LA. Heterosexual HIV-1 Transmission and Viral Load in Hemophilic Patients. Lippincott-Raven Publishers. J. Acquir. Immune Defic. Syndr. 1998:17(1);42-45. 
6. Lucas GM, Chaisson RE, Moore RD. Highly Active Antiretroviral Therapy in a Large Urban Clinic: Risk Factors for Virologic Failure and Adverse Drug Reactions. Ann Intern Med. 1999;131:81-87.
7. CDC. Increases in Unsafe Sex and Rectal Gonorrhea Among Men Who have Sex with Men—–San Francisco, California, 1994-1997. MMWR. 2002.
8. 8. (AIDS 3 2000):297-300.
9. S. Kalichman, D. Rompa, M. Cage, K. DiFonzo, D. Simpson, J. Austin, W. Luke, J. Buckles, F. Kyomugisha, E. Benotsch, S. Pinkerton, J. Graham. Effectiveness of an Intervention to reduce HIV Transmission Risks in HIV-Positive People. Am J Prev Med 2001;21(2):84-92.
10. B. Gerbert, B. Brown, P. Volberding, M. Cooke, N. Caspers, C. Love, A. Bronstone. Physician Transmission Prevention Assessment and Counseling Practices with Their HIV Positive Patients. AIDS Education and Prevention 1999;11(4):307-320.
11. Infectious Disease Society of America Upcoming Practice Guidelines. Integrating HIV Prevention into Primary Medical Care for HIV-Infected Persons (collaboration with CDC). Available at: http://www.idsociety.org.

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[发布日期] 2003-11-18

[学科分类] 医学（综合）