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Prevention counseling for HIV-infected persons: What every clinician needs to know

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Abstract

The absence of adequate and regular prevention counseling during routine clinical encounters translates into missed opportunities for HIV prevention. HIV care providers have considerably more contact with patients than clinicians in other disciplines. These contacts should be translated into opportunities to provide HIV prevention messages to patients and should be a priority for all clinicians caring for HIV-positive patients. Coincidental preventive care for HIV-positive patients is inherently unproductive because of the absence of reinforcing messages. In a recent meta-analysis, HIV-positive individuals who underwent counseling and testing services reduced high-risk behaviors by about 68%. Prevention counseling should focus on positive reinforcement, harm reduction, education, and support. We strongly recommend regular, brief, targeted prevention counseling as a part of every clinical encounter.

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References and Recommended Reading

  1. Grodensky CA, Golin CE, Boland MS, et al.: Translating concern into action: HIV care providers’ views on counseling patients about HIV prevention in the clinical setting. AIDS Behav 2008, 12:404–411.

    Article  PubMed  Google Scholar 

  2. Mayer KH, Safren SA, Gordon CM: HIV care providers and prevention: opportunities and challenges. J Acquir Immune Defic Syndr 2004, 37(Suppl 2):S130–S132.

    PubMed  Google Scholar 

  3. Myers JJ, Rose CD, Shade SB, et al.: Sex, risk and responsibility: provider attitudes and beliefs predict HIV transmission risk prevention counseling in clinical care settings. AIDS Behav 2007, 11:S30–S38.

    Article  PubMed  Google Scholar 

  4. Duffus WA, Barragan M, Metsch L, et al.: Effect of physician specialty on counseling practices and medical referral patterns among physicians caring for disadvantaged human immunodeficiency virus-infected populations. Clin Infect Dis 2003, 36:1577–1584.

    Article  PubMed  CAS  Google Scholar 

  5. Morin SF, Koester KA, Steward WT, et al.: Missed opportunities: prevention with HIV-infected patients in clinical care settings. J Acquir Immune Defic Syndr 2004, 36:960–966.

    Article  PubMed  Google Scholar 

  6. Remien RH, Berkman A, Myer L, et al.: Integrating HIV care and HIV prevention: legal, policy and programmatic recommendations. AIDS 2008, 22(Suppl 2):S57–S65.

    PubMed  Google Scholar 

  7. Del Rio C: New challenges in HIV care: prevention among HIV-infected patients. Top HIV Med 2003, 11:140–144.

    PubMed  Google Scholar 

  8. US Centers for Disease Control and Prevention: Prevention is care campaign. Available at http://www.cdc.gov/hiv/topics/treatment/PIC/. Accessed August 2008.

  9. Kalichman SC, Cain D, Weinhardt L, et al.: Experimental components analysis of brief theory-based HIV/AIDS risk-reduction counseling for sexually transmitted infection patients. Health Psychol 2005, 24:198–208.

    Article  PubMed  Google Scholar 

  10. Wingood GM, DiClemente RJ, Mikhail I, et al.: A randomized controlled trial to reduce HIV transmission risk behaviors and sexually transmitted diseases among women living with HIV: the WiLLOW program. J Acquir Immune Defic Syndr 2004, 37(Suppl 2):S58–S67.

    PubMed  Google Scholar 

  11. Nollen C, Drainoni ML, Sharp V: Designing and delivering a prevention project within an HIV treatment setting: lessons learned from a specialist model. AIDS Behav 2007, 11:S84–S94.

    Article  PubMed  Google Scholar 

  12. Buchbinder S: HIV testing and prevention strategies. Top HIV Med 2008, 16:9–14.

    PubMed  Google Scholar 

  13. Branson BM, Handsfield HH, Lampe MA, et al.: Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006, 55:1–17; quiz CE11–14.

    PubMed  Google Scholar 

  14. Tobias C, Cunningham WE, Cunningham CO, Pounds MB: Making the connection: the importance of engagement and retention in HIV medical care. AIDS Patient Care STDS 2007, 21:S3–S8.

    Article  PubMed  Google Scholar 

  15. Marks G, Crepaz N, Janssen RS: Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS 2006, 20:1447–1450.

    Article  PubMed  Google Scholar 

  16. Marks G, Crepaz N, Senterfitt JW, Janssen RS: Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr 2005, 39:446–453.

    Article  PubMed  Google Scholar 

  17. Greenwald JL, Burstein GR, Pincus J, Branson B: A rapid review of rapid HIV antibody tests. Curr Infect Dis Rep 2006, 8:125–131.

    Article  PubMed  Google Scholar 

  18. Hall HI, Song R, Rhodes P, et al.: Estimation of HIV incidence in the United States. JAMA 2008, 300:520–529.

    Article  PubMed  CAS  Google Scholar 

  19. Centers for Disease Control and Prevention: HIV/AIDS Surveillance Report, 2006, vol 18. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2008:1–55. Available at http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2006report/pdf/2006SurveillanceReport.pdf. Accessed April 2009.

    Google Scholar 

  20. Centers for Disease Control and Prevention: HIV/AIDS Surveillance Report 1996. Available at http://www.cdc.gov/hiv/topics/surveillance/resources/reports/pdf/hivsur82.pdf. Accessed August 2008.

  21. Auerbach JD: Principles of positive prevention. J Acquir Immune Defic Syndr 2004, 37(Suppl 2):S122–S125.

    PubMed  Google Scholar 

  22. Marrazzo J: Sexually transmitted diseases in the HIV care setting: what’s really going on down there? Top HIV Med 2004, 12:57–60.

    PubMed  Google Scholar 

  23. Richardson JL, Milam J, McCutchan A, et al.: Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment. AIDS 2004, 18:1179–1186.

    Article  PubMed  Google Scholar 

  24. Fisher JD, Fisher WA, Cornman DH, et al.: Clinician-delivered intervention during routine clinical care reduces unprotected sexual behavior among HIV-infected patients. J Acquir Immune Defic Syndr 2006, 41:44–52.

    Article  PubMed  Google Scholar 

  25. Centers for Disease Control and Prevention: Incorporating HIV prevention into the medical care of persons living with HIV. Recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep 2003, 52(RR12):1–24. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5212a1.htm. Accessed August 2008.

    Google Scholar 

  26. Kovacs A, Wasserman SS, Burns D, et al. l: Determinants of HIV-1 shedding in the genital tract of women. Lancet 2001, 358:1593–1601.

    Article  PubMed  CAS  Google Scholar 

  27. Lampinen TM, Critchlow CW, Kuypers JM, et al.: Association of antiretroviral therapy with detection of HIV-1 RNA and DNA in the anorectal mucosa of homosexual men. Aids 2000, 14:F69–75.

    Article  PubMed  CAS  Google Scholar 

  28. Zhang H, Dornadula G, Beumont M, et al.: Human immunodeficiency virus type 1 in the semen of men receiving highly active antiretroviral therapy. N Engl J Med 1998, 339:1803–1809.

    Article  PubMed  CAS  Google Scholar 

  29. Sarfaty M: How to increase colorectal screening rates in practice: a primary care clinician’s evidence-based toolbox and guide. Available at http://www.cancer.org/downloads/PRO/ColonMD_Clinicians_Manual_Rev.pdf. Accessed August 2008.

  30. Teti M, Rubinstein S, Lloyd L, et al.: The Protect and Respect program: a sexual risk reduction intervention for women living with HIV/AIDS. AIDS Behav 2007, 11:S106–S116.

    Article  PubMed  Google Scholar 

  31. Raja S, McKirnan D, Glick N: The Treatment Advocacy Program—Sinai: a peer-based HIV prevention intervention for working with African American HIV-infected persons. AIDS Behav 2007, 11:S127–S137.

    Article  PubMed  Google Scholar 

  32. Knauz RO, Safren SA, O’Cleirigh C, et al.: Developing an HIV-prevention intervention for HIV-infected men who have sex with men in HIV care: project enhance. AIDS Behav 2007, 11:S117–S126.

    Article  PubMed  Google Scholar 

  33. Oladapo OT, Daniel OJ, Odusoga OL, Ayoola-Sotubo O: Fertility desires and intentions of HIV-positive patients at a suburban specialist center. J Natl Med Assoc 2005, 97:1672–1681.

    PubMed  Google Scholar 

  34. Finer LB, Henshaw SK: Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health 2006, 38:90–96.

    Article  PubMed  Google Scholar 

  35. Aaron EZ, Criniti SM: Preconception health care for HIV-infected women. Top HIV Med 2007, 15:137–141.

    PubMed  Google Scholar 

  36. Volmink J, Siegfried NL, van der Merwe L, Brocklehurst P: Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection. Cochrane Database Syst Rev 2007:CD003510.

  37. Warszawski J, Tubiana R, Le Chenadec J, et al.: Mother-to-child HIV transmission despite antiretroviral therapy in the ANRS French Perinatal Cohort. AIDS 2008, 22:289–299.

    Article  PubMed  Google Scholar 

  38. Kumwenda NI, Hoover DR, Mofenson LM, et al.: Extended antiretroviral prophylaxis to reduce breast-milk HIV-1 transmission. N Engl J Med 2008, 359:119–129.

    Article  PubMed  CAS  Google Scholar 

  39. Kuhn L, Aldrovandi GM, Sinkala M, et al.: Effects of early, abrupt weaning on HIV-free survival of children in Zambia. N Engl J Med 2008, 359:130–141.

    Article  PubMed  CAS  Google Scholar 

  40. Centers for Disease Control and Prevention: Trends in HIV/AIDS diagnoses among men who have sex with men—33 states, 2001–2006. MMWR Morb Mortal Wkly Rep 2008, 57:681–686. Available at http://www.cdc.gov/mmwr/PDF/wk/mm5725.pdf. Accessed August 2008.

    Google Scholar 

  41. Steward WT, Charlebois ED, Johnson MO, et al.: Receipt of prevention services among HIV-infected men who have sex with men. Am J Public Health 2008, 98:1011–1014.

    Article  PubMed  Google Scholar 

  42. Poudel KC, Poudel-Tandukar K, Yasuoka J, Jimba M: HIV superinfection: another reason to avoid serosorting practice. Lancet 2007, 370:23–23.

    Article  PubMed  Google Scholar 

  43. Tucker JS, Burnam MA, Sherbourne CD, et al.: Substance use and mental health correlates of nonadherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection. Am J Med 2003, 114:573–580.

    Article  PubMed  Google Scholar 

  44. Sohler NL, Wong MD, Cunningham WE, et al.: Type and pattern of illicit drug use and access to health care services for HIV-infected people. AIDS Patient Care STDS 2007, 21:S68–S76.

    Article  PubMed  Google Scholar 

  45. Gaynes BN, Pence BW, Eron JJ Jr, Miller WC: Prevalence and comorbidity of psychiatric diagnoses based on reference standard in an HIV+ patient population. Psychosom Med 2008, 70:505–511.

    Article  PubMed  Google Scholar 

  46. Ammassari A, Antinori A, Aloisi MS, et al.: Depressive symptoms, neurocognitive impairment, and adherence to highly active antiretroviral therapy among HIV-infected persons. Psychosomatics 2004, 45:394–402.

    Article  PubMed  Google Scholar 

  47. Leserman J: HIV disease progression: depression, stress, and possible mechanisms. Biol Psychiatry 2003, 54:295–306.

    Article  PubMed  Google Scholar 

  48. Pence BW, Miller WC, Gaynes BN, Eron JJ, Jr.: Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2007, 44:159–166.

    Article  PubMed  Google Scholar 

  49. Rumptz MH, Tobias C, Rajabiun S, et al.: Factors associated with engaging socially marginalized HIV-positive persons in primary care. AIDS Patient Care STDS 2007, 21(Suppl 1):S30–S39.

    PubMed  Google Scholar 

  50. Chen HT, Grimley DM, Waithaka Y, et al.: A process evaluation of the implementation of a computer-based, health provider-delivered HIV-prevention intervention for HIV-positive men who have sex with men in the primary care setting. AIDS Care 2008, 20:51–60.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Wayne A. Duffus.

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Duffus, W.A., Ogbuanu, I.U. Prevention counseling for HIV-infected persons: What every clinician needs to know. Curr Infect Dis Rep 11, 319–326 (2009). https://doi.org/10.1007/s11908-009-0047-x

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