Reframing "Prevention with Positives": Incorporating Counseling Techniques That Improve the Health of HIV-Positive Patients

Division of Behavioral Sciences, University of California San Francisco, 94117, USA.
AIDS PATIENT CARE and STDs (Impact Factor: 3.5). 02/2006; 20(1):19-29. DOI: 10.1089/apc.2006.20.19
Source: PubMed


Federal HIV prevention strategy seeks to increase efforts by health care providers to identify and reduce their HIV-positive patients' transmission-related behaviors. Implementation of these recommendations will be hindered if providers perceive these efforts have the potential to harm their relationships with patients. Because transmission-related behaviors (unsafe sex and sharing needles) and the related issues of drug and alcohol use also jeopardize the health of HIV-positive patients, providers can use patient-centered counseling when addressing those behaviors. We suggest efforts to increase provider-delivered transmission-prevention counseling be reframed so that "prevention with positives" includes the goal of protecting HIV-positive patients' health. We review the specific consequences of these risky behaviors on HIV-positive patients' health and review brief counseling strategies appropriate for HIV care providers.

Download full-text


Available from: Dale Danley, Oct 06, 2015
24 Reads
  • Source
    • "Psycho-social counselling may be an important component of case management but is also a stand-alone intervention. Gerbert et al. [5] have noted that counselling is one of the most powerful ways to address the psycho-social aspects of HIV, which include managing risky behaviours, coping and social support, depression and treatment adherence [5]. Counselling and case management typically focus on individuals, but health promotion may have a distinctly community focus. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Our objective was to identify all existing systematic reviews related to counselling, case management and health promotion for people living with HIV/AIDS. For the reviews identified, we assessed the quality and local applicability to support evidence-informed policy and practice. We searched 12 electronic databases and two reviewers independently assessed the 5,398 references retrieved from our searches and included 18 systematic reviews. Each review was categorized according to the topic(s) addressed, quality appraised and summarized by extracting key messages, the year searches were last completed and the countries in which included studies were conducted. Twelve reviews address topics related to counselling and case management (mean quality score of 6.5/11). Eight reviews (mean quality score of 6/11) address topics related to health promotion (two address both domains). The findings from this overview of systematic reviews provide a useful resource for supporting the development and delivery of evidence-informed support services in community settings. Electronic supplementary material The online version of this article (doi:10.1007/s10461-012-0283-1) contains supplementary material, which is available to authorized users.
    AIDS and Behavior 09/2012; 17(5). DOI:10.1007/s10461-012-0283-1 · 3.49 Impact Factor
  • Source
    • "While HIV prevention interventions increasingly target the risk behaviour of HIV-infected individuals [1–3], few have tried to take advantage of the potential of PLHA to be key facilitators of secondary prevention. Peer outreach strategies for HIV prevention have been used among at-risk populations including drug users [4–6] and sex workers [7]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: HIV prevention efforts to date have not explored the potential for persons living with HIV to act as change agents for prevention behaviour in their social networks. Using egocentric social network analysis, this study examined the prevalence and social network correlates of prevention advocacy behaviours (discussing HIV in general; encouraging abstinence or condom use, HIV testing, and seeking HIV care) enacted by 39 HIV clients in Uganda. Participants engaged in each prevention advocacy behaviour with roughly 50-70% of the members in their network. The strongest determinant of engaging in prevention advocacy with more of one's network members was having a greater proportion of network members who knew one's HIV seropositive status, as this was associated with three of the four advocacy behaviours. These findings highlight the potential for PLHA to be key change agents for HIV prevention within their networks and the importance of HIV disclosure in facilitating prevention advocacy.
    AIDS research and treatment 05/2012; 2012:815823. DOI:10.1155/2012/815823
  • Source
    • "The HIV primary care setting may similarly present a good opportunity to prevent and treat alcohol consumption among HIV-positive patients. Past studies have focused on discussions of sexual risk behavior, medication adherence, and injection drug use behavior by HIV primary care providers with their HIV-positive patients (Fisher et al., 2006; Gerbert et al., 2006; Metsch et al., 2004; Morin et al., 2004; Richardson et al., 2004; Wilkinson et al., 2006). To date, however, there have been no published studies of efficacious interventions that address the discussion of alcohol use in the HIV primary care setting, including provider-based interventions. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We investigated the prevalence of HIV-positive patients discussing alcohol use with their HIV primary care providers and factors associated with these discussions. We recruited 1225 adult participants from 10 HIV care clinics in three large US cities from May 2004 to 2005. Multivariate logistic regression analysis was used to assess the associations between self-reported rates of discussion of alcohol use with HIV primary care providers in the past 12 months and the CAGE screening measure of problem drinking and sociodemographic variables. Thirty-five percent of participants reported discussion of alcohol use with their primary care providers. The odds of reporting discussion of alcohol were three times greater for problem drinkers than for non-drinkers, but only 52% of problem drinkers reported such a discussion in the prior 12 months. Sociodemographic factors associated with discussion of alcohol use (after controlling for problem drinking) were being younger than 40, male, being non-white Hispanic (compared with being Hispanic), being in poorer health, and having a better patient-provider relationship. Efforts are needed to increase the focus on alcohol use in the HIV primary care setting, especially with problem drinkers. Interventions addressing provider training or brief interventions that address alcohol use by HIV-positive patients in the HIV primary care setting should be considered as possible approaches to address this issue.
    Drug and Alcohol Dependence 06/2008; 95(1-2):37-44. DOI:10.1016/j.drugalcdep.2007.12.006 · 3.42 Impact Factor
Show more