Objective 1: Among people living with HIV, increase the proportion who consistently engage in behaviors that reduce risk for HIV transmission or acquisition.

Two AHP demonstration projects focused on implementing new models of diagnosing HIV infection outside medical care settings and preventing new infections by working with persons diagnosed with HIV and their partners. The first project, “Incorporating HIV Prevention into Medical Care Settings,” used an intervention called Positive S.T.E.P.S (Striving to Engage People) to explore the effects of clinic-based repeated, brief prevention counseling on patient behaviors and sexually transmitted diseases (STDs). The project was implemented in HIV outpatient clinics. It provided an opportunity to reach large numbers of HIV-infected individuals who visit the clinic on a regular basis, to implement safer-sex and needle-sharing intervention, to integrate the intervention with routine clinical care, and to involve nurses and physicians in the intervention. Because some individuals, after testing positive for HIV, fail to change risky behaviors, ongoing, brief prevention counseling is a cost-effective measure that can be incorporated into routine care for HIV-infected individuals.

CDC supported six sites in implementing the 2003 Incorporating HIV Prevention into Medical Care Settings Guidelines —recommendations developed by CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America, to help health care providers incorporate HIV prevention into the medical care of people with HIV. The six sites assessed the impact of the guidelines on reported risk behaviors, STD rates, tailored risk reduction counseling, and referrals. As of August 2005, 1109 persons had enrolled in the program, the intervention had been delivered to all patients attending the clinics, and the clinics were conducting 6- and 12-month follow-up assessments.

The second AHP demonstration project, “Prevention Case Management for People Living with HIV/AIDS,” was a client-centered HIV prevention activity that combined HIV risk-reduction counseling and traditional case management to provide intensive, on-going, individualized prevention counseling and support. Nine CBOs were funded in Maryland, Massachusetts, Michigan, Missouri, California, Pennsylvania, New York, and Washington, D.C., to provide specialized assistance through prevention case management, to HIV-infected persons with multiple and complex HIV risk-reduction needs. Through this project, CDC's aim was to monitor risk reduction behavior change of HIV-infected persons by providing individualized, multiple-session HIV reduction counseling to prevent the transmission or acquisition of HIV, assess risks of other sexually transmitted infections, and ensure appropriate diagnosis and adequate treatment.

In 2005 and 2006, CDC published in its Morbidity and Mortality Weekly Report preliminary findings from a study of MSM in the National HIV Behavioral Surveillance System (NHBS), results of a meta-analysis study of high-sexual behavior in persons aware and unaware of their serostatus, and results of a second meta-analysis of HIV prevention interventions for people living with HIV.

Data from NHBS on HIV prevalence and unrecognized HIV infection among MSM in five cities found an overall HIV prevalence rate of 25%. Rates varied by race/ethnicity and rates were highest among African-American MSM (46%), followed by white MSM (21%), and Hispanic MSM (17%). Among the HIV-infected MSM, 48% were unaware that they were infected with HIV.

Go to Goal 1, Objectives 2 to 4