A few years ago, part of the HIV social service community in California developed a new prevention program. They called it "Prevention for Positives." (Here at TPAN, we call it "Prevention With Positives," a minor change, but without some of the assumptions and stings of the original.) The CDC heard about it. They studied and discussed the merits and downfalls of the program. Finally, they developed a nationwide prevention initiative which they now highly encourage prevention programs to embrace.
The new initiative called for four key strategies.
- Make HIV testing a routine part of medical care.
- Implement new models for diagnosing HIV infections outside medical settings.
- Further decrease perinatal HIV transmission.
- Prevent new infections by working with persons diagnosed with HIV and their partners.
At its core, prevention with positives follows a harm reduction model. It integrates prevention and care. Many positives believe that unprotected sexual acts and sharing needles with other infected people carries with it minimal or no risk. Through Prevention With Positives, they begin to understand that "sero-sorting" (only engaging in risky behaviors with other HIV-positive people) does not always guarantee safety for themselves or their partners. Properly implemented, the program communicates risk, but no judgment. The program discusses abstinence, but does not push it. The program imparts scientific knowledge, but it relies on the client to use the knowledge.
In order to achieve these tasks, agencies across the country have begun to implement educational programs for their clients following guidelines set by the CDC, but they modify these guidelines to fit the face of their community. TPAN developed an 18-hour class called TEAM -- Treatment, Education, Advocacy, Management -- which is presented to clients and providers six times a year. Many important issues surrounding the healthy lifestyle of an HIV-positive person are discussed. They include, but are not limited to, re-infection, co-infection, and treatment.
Re-Infection and Mutation
While originally a theory, well documented cases of re-infection have now been reported. Essentially, re-infection means that another strain of the virus takes hold in your body. This can be potentially disastrous to a person's health. If an HIV-positive person receives a new strain that no longer responds well to treatment, that person runs the risk of treatment failure, or at the very least, he or she may limit treatment options for themselves. This phenomenon is somewhat rare, but barriers (e.g., condoms) during sex with an HIV-positive partner should be used in order to minimize the risk.
Co-Infection and STDs
Taking unprotected risks with HIV-positive partners sometimes puts a positive person in danger of receiving another infection. While many STDs such as gonorrhea, chlamydia and syphilis can be treated with antibiotics, others cannot be successfully treated, or they are significantly more difficult to treat. Hepatitis C is a common co-infection that affects and infects those who take both sexual and intravenous drug use risks. Interferon has proven to be an effective treatment; however, according to the latest data, it only works in about 30-40% of cases in HIV-positive people (60% in HIV-negative cases). HPV and herpes have treatments to control the infections, but in most cases the body's immune system never completely clears the infections. With certain strains of anal and vaginal HPV, cancer can result, especially in the presence of a compromised immune system. It should be noted that condoms do not always provide an effective barrier against HPV and herpes; however, they do minimize risk of exposure.
This is not theory. This is not conjecture. An HIV-positive person should find a doctor who has experience treating HIV-positive clients and who listens to the problems and concerns of their clients. They should also be open and honest with their doctor. Through a good relationship with an educated doctor, a person can make informed decisions regarding their health. Feeling empowered over a situation that often makes people feel powerless provides the upper hand in the battle to defeat this disease.
In my work in HIV prevention and education, I hear the community's concerns. Many of them fear that Prevention With Positives stigmatizes positive people by putting all the responsibility of healthy decisions on them. While some individuals promoting this program see it that way, many of us see it as an opportunity to empower people living with HIV to live happy, healthy, long lives with minimal added stress to what is already a stressful situation. Others believe that the prevention focus should not be shifted from negatives to positives. After all, prevention failed the positives we already have, therefore why should HIV-positive people carry all the burden of the disease and of their partners? I understand this point of view, but I do not agree with it. I also do not agree that the focus should be completely shifted away from negative individuals. Through concentrated educational efforts towards both negative and positive populations, perhaps the tide will finally shift against this pandemic.