Messages HIV clinicians use in prevention with positives interventions

Abstract

Prevention with Positives (PwP) is a component of the US HIV prevention strategy that targets HIV-infected persons who are aware of their seropositive status. This paper examines the use of prevention messages by clinical providers during the PwP intervention period of the US Health Resources and Services Administration's Special Projects of National Significance program. Quantitative approaches were used to learn which prevention topics were most discussed and qualitative interviews were also utilized to better understand the clinician perspective in providing prevention counseling. At 12-month follow-up, there was a significant increase in the percent of patients receiving all PwP counseling messages (p<0.01). Providers reported discussing safer sex with 91% of patients when sexually transmitted infection (STI) screening was conducted during a visit, an increase from baseline (83.5%). The percent of providers reporting they regularly explained the risk of superinfection to their clients also increased from 75% at baseline to 90% at 12-month follow up (p<0.001). Qualitative data suggest that providers prioritize individual care over public health approaches to PwP in counseling. Discussing superinfection offered providers a way to discuss HIV prevention from a non-judgmental clinical perspective while focusing on a patient-centered philosophy of care. However, the threat of superinfection may not be the best counseling option. Examples such as STI screening, giving messages to reduce the number of sexual partners and adherence to medication, are more evidence-based approaches to changing HIV transmission risk behavior and may be more important in PwP. Findings suggest that in order for HIV care providers to incorporate HIV prevention discussions into their practice, acceptable approaches to speaking about risk behavior and prevention of HIV transmission must be developed.

Keywords:

• SPNS PwP initiative
• Prevention with Positives (PwP)
• superinfection
• risk reduction counseling
• HIV prevention
• behavioral intervention

Acknowledgements

This study was funded by the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) initiative. The authors would like to thank the many HIV-infected individuals who participated in these research studies, all the research staff for their dedication and effort, and the staff of the participating medical clinics for their support. We also thank Sarah A. Gutin and Laura Rafferty-Jacobo for editing and preparing this manuscript for publication.