Historically, HIV prevention programs have focused primarily on developing risk reduction interventions for those at high risk for becoming infected with HIV. In 1999, a review of 55 state and city applications to the CDC for funds for HIV prevention programs demonstrated that only 18 (32.7%) listed HIV-infected individuals as a priority population for HIV prevention programs. Although there are millions of people in the United States at "behavioral risk" for HIV infection, transmission can occur only from people who are infected with the virus. As the number of individuals with HIV continues to increase because of ART, so does the urgency for lifelong prevention strategies customized for them. The 1996 International AIDS conference in Vancouver, British Columbia, marked the beginning of a new treatment era in the AIDS epidemic, making knowledge of serostatus and linkage to prevention and treatment services more important than ever before.
At a time of increasing risk behavior in some communities with high HIV prevalence and among an increasing number of individuals with HIV infection, SAFE strategies for HIV-infected persons represent a logical evolution of prevention in an era of improved treatment. Such an approach couples a traditional infectious disease control focus on the infected person with behavioral interventions that have become standard elements in HIV prevention programs. In this new era, for individual as well as public health reasons, every person infected with HIV should be voluntarily diagnosed, evaluated medically, treated according to state-of-the-art guidelines, and provided with appropriate prevention services.
In combination with current programs focusing on HIV-negative individuals, SAFE offers an unprecedented opportunity for significantly reducing HIV transmission and HIV-associated morbidity and mortality.