‘Positive prevention’ and its implications for responsibility

Edwin J. Bernard
Published: 18 July 2010

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To date, many positive prevention programmes have placed an undue burden of responsibility for HIV transmission on HIV positive people. The technical consultation was an opportunity to collectively frame policies and programmes within a human rights perspective and to shift the focus of preventing HIV transmission to a shared responsibility of all individuals irrespective of HIV status.

Kevin Moody, Global Network of People Living with HIV (GNP+), 2009.1

Until relatively recently, HIV prevention interventions aimed explicitly at people who know their HIV-positive status were rare, although some prevention campaigns had made explicit attempts to ensure they did not exclude people who knew they were HIV-positive. What became known as ‘positive prevention’ became formalised in 2003, when the CDC announced a new national initiative focused on “prevent[ing] new infections by working with persons diagnosed with HIV and their partners.”2

The CDC called for incorporating HIV prevention into the ongoing medical care of all HIV-positive people in clinical settings; providing those individuals with brief behaviour risk-reduction interventions in the clinic setting with referrals for additional prevention and related services; and also providing counselling and referral services to their partners.3

Although taking further measures to support HIV-positive people’s HIV prevention efforts may in itself seem like a reasonable public health strategy, how the strategy is framed has important implications for people living with HIV. The CDC approach – to ask diagnosed HIV-positive people to discuss their sexual risk-taking behaviour and to name their sexual contacts who may have been exposed to HIV – was criticised by people living with HIV, their advocacy allies and legal experts for “placing the responsibility for avoiding infections on the shoulders of HIV-positive people”4 and, in states where individuals could be prosecuted for having unprotected sex with or without disclosing their HIV-positive status, “expos[ing] patients to an unacknowledged risk of criminal prosecution.”5

Since then, internationally focused programmatic guidance on ‘positive prevention’ has been developed by number of organisations, including the CDC,6 the International HIV/AIDS Alliance,7 UNAIDS8,9 and the World Health Organization (WHO).10 Despite these efforts, there remains a lack of clarity about the concept, in particular whether its main beneficiary is people with HIV or broader public health aims.11

Subsequently, in 2009, the Global Network of People Living with HIV (GNP+), in partnership with UNAIDS, established a new, human rights-based approach to positive prevention known as “positive health, dignity and prevention.” This links HIV prevention with programmes that aim to improve the wellbeing of people living with HIV. Key elements include  ensuring access to not just to antiretroviral treatment, but more holistic care, including sexual and reproductive health, and psychosocial wellbeing including integrated mental health services. One of the key principles of positive health dignity and prevention is that “preventing HIV transmission is a shared responsibility of all individuals irrespective of HIV status” which ideally “requires a supportive and protective legal and policy environment free of stigma and discrimination.”11

References

  1. GNP+, UNAIDS Moving forward on ‘Positive Health, Dignity and Prevention’ – people living with HIV set principles for engagement. Press Release, May 9, 2009
  2. CDC Advancing HIV Prevention: New Strategies for a Changing Epidemic – United States, 2003. MMWR 2003; 52: 329-332, 2003
  3. CDC Incorporating HIV prevention into the medical care of persons living with HIV. MMWR 2003: 52 (RR-12): 1-24, 2003
  4. Anderson T Expanding the Boundaries of Positive Prevention Programmes. National Association of People with AIDS (NAPWA). Presented at 4th Annual CAPS Conference, San Francisco, 2004
  5. Webber DM Self-Incrimination, Partner Notification, and the Criminal Law: Negatives for the CDC’s “Prevention for Positives” Initiative. AIDS & Public Policy Journal 19 (1/2): 54-66, 2004
  6. CDC HIV Prevention for People Living with HIV: an Intervention Toolkit for HIV Care and Treatment Settings. Atlanta, Centers for Disease Control and Prevention, 2008
  7. International HIV/AIDS Alliance Positive Prevention: HIV Prevention for People with HIV. Brighton, 2007
  8. UNAIDS Intensifying HIV prevention: a UNAIDS policy position paper. Geneva, 2005
  9. UNAIDS Practical Guidelines for Intensifying HIV Prevention: Towards Universal Access. Geneva, 2007
  10. World Health Organization Essential Prevention and Care Interventions for Adults and Adolescents Living with HIV in Resource- Limited Settings. Geneva, 2008
  11. GNP+, UNAIDS Positive Health, Dignity and Prevention. Technical Consultation Report. Amsterdam, 2009
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
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We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

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The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.