CDC releases guidelines on prevention for positives

The Centers for Disease Control and Prevention, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America on Thursday released new guidelines for doctors and other health care providers to help make HIV prevention a part of routine care for their HIV-positive patients. The guidelines suggest that health providers follow three steps: screening their patients for high-risk behaviors and the presence of other sexually transmitted diseases; discussing risk reduction strategies, including condom use and the importance of not sharing needles for injection drug use; and encouraging HIV-positive people to disclose their status to sex and drug partners, who also should be tested for HIV antibodies. The recommendations are "general and apply to incorporating HIV prevention into the medical care of all" HIV-positive adolescents and adults, "regardless of age, sex, or race/ethnicity," the guidelines state. The guidelines were released as part of the CDC's refocusing of its HIV prevention efforts to get more Americans tested for HIV antibodies and to stress prevention efforts aimed at those who are HIV-positive. The new emphasis, announced in April, could result in the shifting of as much as $90 million away from traditional HIV outreach to programs emphasizing testing and prevention for positives in fiscal 2004. "We focused in the past on people at risk of becoming infected," Robert Janssen, head of the CDC's Division of HIV/AIDS Prevention, told the Atlanta Journal-Constitution. "Now we're trying to bring up to speed interventions for people who are infected and can transmit the virus to others. " CDC Director Julie Gerberding added, "It's time we merge prevention services for HIV-infected persons into the mainstream of medical care." AIDS activists and officials with HIV/AIDS service organizations around the country have questioned the CDC's new prevention focus, with a particular worry that a shift in prevention funds will cripple existing programs that aim to keep HIV-negative people from becoming infected with the virus. Some clinicians also believe that many doctors who are already overworked will not have time to begin delivering HIV prevention services to their patients. Other physicians may struggle with exactly how to make HIV prevention part of routine care for HIV-positive patients. Ronald Valdiserri, deputy director of the CDC's National Center for HIV, STD and TB Prevention, agreed that some doctors may have difficulty delivering prevention messages. "It's not the easiest thing for many physicians to be able to talk about sex and drug use with their clients," he said. But Valdiserri noted that studies have shown that doctors who go through even just one day of HIV prevention training are able to significantly improve their ability to talk with their patients about high-risk behaviors and harm reduction.