Upload
kelley-lambert
View
212
Download
2
Embed Size (px)
Citation preview
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/