JORDAN E. LAKE, MD, MSCAAHU AUGUST 2015

Prevention for Positives

PREVENTION FOR POSITIVES?

What is

Prevention for Positives (PWP)

CDC initiative

Initial Goals:• increased HIV testing in medical settings• increased use of new testing technologies• prevention of transmission from HIV+ persons to

sex and needle sharing partners• prevention of perinatal transmission

Now: “A holistic and system level approach to risk reduction” aimed at High Impact Prevention in the U.S.

Prevention for (with) Positives (PWP)

PWP means helping HIV+ persons learn how to

• Prevent transmitting HIV to someone else

• Optimize self health and behaviors

Prevention for (with) Positives (PWP)

Can you name some PWP techniques?

Prevention for Positives (PWP)

10 components:-linking every person living with HIV to medical care-retaining patients in care-prescribing ART to all patients-helping patients maintain adherence to treatment-providing partner services-screening for HIV risk/referring to risk reduction programs-giving referrals to other supportive services-screening for sexually transmitted infections and supplying related services-delivering appropriate reproductive health care -preventing mother-to-child transmission of HIV 

http://www.cdc.gov/hiv/prevention/programs/pwp/index.html

PWP for Developing Countries

http://www.who.int/bulletin/volumes/88/8/09-068213/en/

GETTING PATIENTS IN CARE AND KEEPING THEM THERE

PWP

http://www.cdc.gov/hiv/prevention/programs/pwp/linkage.html

http://www.cdc.gov/hiv/prevention/programs/pwp/linkage.html

PREVENTING HIV WITH ART

PWP

HPTN 052

Cohen MS et al. N Engl J Med 2011;365:493-505.

N Engl J Med 2000; 342:921-929

HIV MEETS THE “OTHER” STIs

PWP

STIs and HIV Transmission

An HIV+ person with and STI is more likely to transmit HIV through sexual contact

Ulcers, inflammation, increased HIV in genital secretions

1. Wasserheit JN. 1992. Sexually Transmitted Diseases 9:61-77. 2. http://www.cdc.gov/std/hiv/stdfact-std-hiv.htm

STIs and HIV Transmission: Test Frequently and

OTHER STRATEGIES

PWP

Risk Reduction as PWP

Counseling and education regardingSexual practicesSTI historySubstance useDomestic violenceFood and housing securityFertility desiresHIV disclosure

Access to services such as needle exchange, substance abuse treatment, shelters, etc.

Risk Reduction as PWP

For your clients, which risk reduction services are most important?

Disclosure: Do the Right Thing

Disclosure: Teaching Others To Do the Right Thing Too

Barriers to Risk Reduction Implementation

The provider/client environment has to be and feel non-judgemental

Providers have to ask!

Providers need time to educate and available referral services

Clients have to be engaged and want to implement change

Barriers to Risk Reduction Implementation

Providers have to ask!

Barriers to Risk Reduction Implementation

Clients have to be engaged and want to implement change

The Engaged Client: Self-Management

http://www.treatmentactiongroup.org/tagline/2014/spring/forgotten-negatives-limits-treatment-prevention

PWP: It Takes a Village!

http://www.hivpwp.org/