You might assume that HIV-treating clinicians -- doctors, mid-level providers, and nurses, among others -- make prevention of HIV transmission a priority in daily practice. If so, your assumption is understandable. It's also wrong. According to editor Mark Mascolini, "[E]ven while a raft" of research shows that "simple, regular counseling by HIV providers defuses risky behavior," between a third and three fourths of HIV providers don't offer it. In this issue of RITA!, Mascolini explores the reasons why.
Still, even while counseling for behavior change is essential, it's probably not the most important weapon in the clinician's arsenal. "If every HIV-positive person had an undetectable viral load," says Joel Gallant of Johns Hopkins University, "the epidemic would be over." Treating HIV-positive patients with antiretroviral therapy is, he says, the "single most important thing" providers can do to stymie the transmission of HIV. The data support his claims. In a study of nearly 1800 serodiscordant couples, treating the infected partner with antivirals reduced the risk of HIV transmission to the uninfected partner by an astonishing 96%.
"Positive prevention" -- helping HIV-positive individuals to stop transmitting the virus -- is the focus of this issue of RITA!. As Mascolini notes, "Everyone who gets HIV gets it from someone else." In the United States, where men who have sex with men remain the group most vulnerable to infection, the lifetime risk for viral acquisition is shocking: For white males, it's 1 in 104; for Hispanic males, 1 in 35; and for black males, 1 in 16. "If you told people they had a 1 in 16 to 104 lifetime chance of dying in a plane crash," Mascolini asks, "how many people would fly?"
Though some of the numbers are startling, others are heartening. For example, from 1984 to 2006, HIV transmission in the US declined by 90%; it's declined by more than 33% since 1997. Here, we review the ways -- many of them simple, quick and readily available -- to help reduce the numbers still further. So if you're looking not just for a description of the problem, but also for solutions, turn the page.