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Prevention with Persons with HIV

The Context of Prevention

Several individual, social, ethical, legal, policy, and programmatic issues shape the lives of persons with HIV and their ability to adopt strategies to prevent HIV transmission over their lifetimes. Providers who understand how these issues influence their clients and patients are prepared to

  • create a sense of shared responsibility for HIV prevention with persons with HIV;
  • communicate in a sensitive, respectful, and culturally competent manner;
  • motivate persons with HIV to identify and adopt realistic prevention strategies;
  • help persons with HIV obtain essential medical and social services and overcome barriers to accessing these services;
  • recognize how individual, social, ethical, legal, policy, and programmatic issues drive HIV transmission in their communities; and
  • promote the development of community resources to address these problems.

ContextThe forthcoming recommendations will address:

  • protecting privacy and confidentiality;
  • promoting HIV disclosure using methods that avoid negative consequences;
  • preventing discrimination and stigma;
  • delivering HIV prevention services in an ethical, respectful, and culturally competent manner; and
  • supporting adequate HIV prevention resources and a well-trained, multidisciplinary workforce.

Most of the forthcoming recommendations are consistent with recommendations from existing federal government guidance and standards for these types of providers:

Clinicians and HIV prevention providers in non-clinical settings

  • Offer services in a nonjudgmental manner that supports a person’s informed decisions about HIV care and prevention services and that fosters development of self-management skills (e.g., supporting a person’s preference to access a syringe - exchange program before substance use treatment, eliciting personalized cues to support antiretroviral therapy adherence).5,6
  • Demonstrate respect and avoid acting in a discriminatory, stigmatizing, or judgmental manner about
    • behaviors related to HIV infection, sexual identity, sex, age, drug use, and pregnancy; and
    • medical or social characteristics, such as mental illness, poverty, and homelessness.5-7
  • Encourage persons with HIV to disclose their HIV infection status using methods that emphasize the benefits of disclosure (e.g., improved access to services and social support) and minimize potential risks (e.g., stigma, discrimination, and risk of prosecution for intentional HIV exposure).5,6
  • Protect privacy and confidentiality of personal and health information when providing prevention services and exchanging health information.5,6,8-10
  • Become familiar with social, ethical, legal, structural, policy, and program issues that can affect prevention with persons with HIV and how these issues define a person’s prevention service priorities.5,6,11
  • Become familiar with local governmental and non-governmental agencies that provide HIV prevention and care services for persons with varying financial resources, insurance coverage, and eligibility for public sector HIV care and prevention programs.5,11
  • Participatein comprehensive provider networks and formal interagency collaborations that expand access to HIV prevention and care services offered by clinicaland non-clinical providers, medical and social services agencies, and health departments.5,6,8,11
  • Comply with state regulationsabout minors’ rights to access and consent to HIV prevention services without consent of parents or guardians.5,9

Health departments and HIV planning groups1

  • Before releasing HIV surveillance data, develop policies and practices that define uses of surveillance data for HIV prevention services; e.g., to identify persons with HIV who can be linked to HIV care services or partner services.5,12,13
  • Develop, maintain, or disseminate updated directories of organizations and providers that offer services to persons with HIV, including persons eligible for Medicaid, Ryan White programs,2 other state and federal HIV programs, and private health insurance.5,11,14
  • Promote initiatives to expand access to affordable HIV services, HIV provider networks, and HIV provider training, and to increase the number of skilled prevention providers.5,11,13,14

1HIV planning groups are official, non-governmental organizations composed of HIV service psroviders, members of populations affected by HIV, and technical experts who provide input to a health department’s jurisdictional HIV Prevention Plan.

2 The Ryan White Care Act provides prevention and care services for persons with HIV.

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