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AIDS Action Weekly Update Special Edition

Report From the HIV Prevention Leadership Summit
Atlanta, Georgia, June 16-19, 2004

June 25, 2004

The Plenary Experience

Initiatives in HIV Prevention and Care Linkages


Ever since the CDC released Advancing HIV Prevention in April 2003, one of the guidance's most hotly debated elements has been its "prevention for positives." In this plenary, "Initiatives in HIV Prevention and Care Linkages," Dr. Robert Janssen, director of the Division of HIV/AIDS Prevention, outlined the rationale behind the CDC's choice to emphasize education and risk-reduction messaging for HIV-positive people in health care settings, including the doctor's office. According to Dr. Janssen, the "philosophy" behind the new initiative is science-based: 70% of people living with HIV in the U.S. are sexually active, and it has been shown that once people know they are HIV positive, they are far more likely to use strategies that reduce the risk of transmission. Consequently, there is value in teaching HIV-positive people about such strategies.

Melanie Thompson, a doctor and researcher at the AIDS Research Consortium of Atlanta, agreed with Dr. Janssen. "Everyone [meaning care providers] thinks prevention in care is a good idea -- for the first five minutes." Then anxiety sets in, she explained. An HIV care provider herself, Dr. Thompson revealed that health care providers are often hesitant to discuss certain topics, including condom use and injection drug use. "We're comfortable talking about certain things, like antiretroviral therapy and CD4 counts, but it's difficult for us to get outside [the clinical] box."

Time is another common concern, she explained. Many health care providers worry about the amount of time that prevention discussions require. To illustrate how tight a health care providers schedule can be, Dr. Thompson offered her schedule on a typical day. Among her other daily responsibilities, Dr. Thompson sees about 30 patients, giving her fifteen minutes with each client on average. Within that time, she must often address an array of complex medical challenges confronting her clients. How can she do prevention counseling without compromising the quality of her medical services, she wonders. Moreover, time constraints can also prevent service providers from getting the training necessary for prevention work.

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If health care providers are to be successful in this new endeavor, the "culture of our clinical care" must change to a "prevention culture," Dr. Thompson concluded. In this new culture, staffs at medical centers would have the time to receive proper training and education; there would be posters and other visual reminders of the importance and means of prevention; discreet reading materials would be available in waiting rooms for clients; and while it may be costly, she also believes it is both important and possible for health centers to provide free condoms. Lastly, she recommended that there be "a push" for Medicare and Medicaid to reimburse fees, at least partially, for evidence-based prevention services.

As one of the final two speakers, Douglas Morgan of the HIV/AIDS Bureau, an office within HRSA, explained how the Ryan White CARE Act (RWCA) provides opportunities to integrate prevention and care. Mr. Morgan's remarks were followed by the observations of an advocate who has been living with HIV for 14 years. She began by saying that her two sons are the driving force behind her advocacy work. In telling her story to others, she hopes to "set a foundation of knowledge and strength so that [her boys] might lead a life free of HIV." Diagnosed days before Thanksgiving in 1990, she said that one of the first questions she had been asked by the doctor was "Who do you need to tell?" She recounted this story to illustrate that HIV-positive people have always been an integral part of prevention. "Prevention begins at diagnosis," she explained. Well before the CDC devised its Advancing HIV Prevention initiative, HIV-positive people contributed greatly to efforts to reduce transmission and, in this way, have been a "vital part of care." She continued, "Care is prevention and prevention is care."

A Webcast of this plenary is available at www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detailandhc=1182.


Back to the AIDS Action Weekly Update June 25, 2004 contents page.




  
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This article was provided by AIDS Action Council. It is a part of the publication AIDS Action Weekly Update.
 

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