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Incorporating a comprehensive HIV prevention approach into your practice

The first step in HIV prevention is starting a conversation with your patients to identify if they are at risk. Ask them about their sexual preferences, recent sexual encounters, and discuss safer sexual practices that could benefit them.1

  • Prevent HIV: Discuss Sexual History

    Sexual History

  • Prevent HIV: HIV and STI Testing

    Testing

  • Prevent HIV: Regular Condom Use

    Condoms

  • HIV prevention medication

    Medication

You can help protect your patients by utilizing a comprehensive approach. Be proactive. Combine routine HIV and STI testing with sexual history conversations and education on the importance of condoms. For HIV-positive patients, initiating and adhering to treatment helps prevent HIV transmission to negative partners. For HIV-negative patients at risk of HIV infection, consider additional prevention methods such as behavioral counseling, PrEP (pre-exposure prophylaxis), and PEP (post-exposure prophylaxis).1

You can help protect your patients by utilizing a comprehensive approach. Be proactive. Combine routine HIV and STI testing with sexual history conversations and education on the importance of condoms. For HIV-positive patients, initiating and adhering to treatment helps prevent HIV transmission to negative partners. For HIV-negative patients at risk of HIV infection, consider additional prevention methods such as behavioral counseling, PrEP (pre-exposure prophylaxis), and PEP (post-exposure prophylaxis).1

  • Sexual history icon

    Sexual History

  • Testing icon

    Testing

  • Safe sex icon

    Condoms

  • Medication icon

    Medication

Components of a comprehensive HIV prevention approach

ALL PATIENTS

  • Sexual Health Conversations1:

    A sexual history conversation should take place during a patient's initial visit, during routine preventive exams, and when you see first signs of STIs. A sexual history conversation allows you to identify individuals at risk for STIs, including HIV.

  • Sex Education2,3:

    Educate your patients with up-to-date information about STIs, HIV, and safer sex practice options, to help them establish a healthy understanding of what safer sex truly means today. Appropriate use of condoms should be discussed with every sexually active individual.

  • Regular Testing4:

    Regular testing for STIs and HIV is important for all sexually active individuals, especially those at higher risk for HIV. It is recommended that individuals at risk get tested every 3 to 6 months, depending on their risk factors.

HIV-Infected Patients

  • Condoms3:

    Regular use of condoms should be discussed with every sexually active individual.

  • TasP (Treatment as Prevention)2,5:

    TasP refers to the use of antiretroviral therapy (ART) by an HIV-positive individual in order to suppress viral load in bodily fluids, thereby reducing the chances that HIV will be transmitted to an HIV-negative partner. TasP is recommended by the CDC and WHO in combination with safer sex practices for individuals who are living with HIV. The National HIV/AIDS Strategy for the United States (NHAS) estimates that diagnosing people living with HIV and providing prompt treatment could prevent more than 90% of new infections.

HIV-Uninfected patients AT RISK OF INFECTION

  • Condoms3:

    Regular use of condoms should be discussed with every sexually active individual.

  • Behavioral Counseling1,6:

    If an individual is at particular risk of contracting HIV, a conversation about healthy habits may be necessary. Condomless sex, the number of partners, frequency of sexual encounters, and sexual networks (groups of persons connected to one another sexually) contribute to the likelihood of contracting HIV. For injection drug users, you can provide referrals to substance abuse treatment programs and sterile syringe programs.

  • PrEP (Pre-Exposure Prophylaxis)1,2,7:

    PrEP is the use of daily ARV medications in combination with safer sex practices to help reduce the risk of HIV infection in an HIV-negative person. Before PrEP is prescribed, HIV testing and symptom history must exclude an HIV infection. It is to be used along with regular HIV/STI testing, as well as periodic counseling and support around adherence and sexual choices. PrEP is recommended by the CDC, WHO, and NHAS as part of a comprehensive prevention approach for individuals at substantial risk of HIV infection.

  • PEP (Post-Exposure Prophylaxis)7-10:

    PEP is the use of ARV medications after an uninfected person has come into contact with bodily fluids that represent a substantial HIV risk. PEP can be used to treat uninfected people after an occupational exposure to HIV, such as a being stuck by a needle. It can also be used to treat uninfected people who have experienced a non-occupational event that has put them at risk of HIV infection, such as unprotected sex with an HIV-positive partner. A PEP regimen must be administered within 72 hours of the exposure and medication must be taken daily for 28 days. PEP is recommended by the CDC, WHO, and IAS-USA in combination with safer sex practices for individuals at substantial risk of HIV infection.

"Behavioral interventions that have been proven highly effective in reducing HIV risk at the lowest cost should be prioritized, and delivered in conjunction with other effective strategies.... Behavioral interventions that particularly support engagement in care and adherence to treatment and that enable individuals to successfully adhere to PrEP or PEP are essential components of the effective use of these biomedical interventions."
—National HIV/AIDS Strategy for the United States

Behavioral interventions reduce HIV risk Behavioral interventions reduce HIV risk

References: 1. Centers for Disease Control and Prevention. Preexposure prophylaxis for the prevention of HIV infection in the United States–2014: a clinical practice guideline. http://www.cdc.gov/hiv/pdf/guidelines/PrEPguidelines2014.pdf. Published 2014. Accessed May 18, 2016. 2. White House Office of National AIDS Policy. National HIV/AIDS Strategy for the United States: updated to 2020. https://www.aids.gov/federal-resources/national-hiv-aids-strategy/nhas-update.pdf. Published July 2015. Accessed May 9, 2016. 3. Centers for Disease Control and Prevention. Condom effectiveness. http://www.cdc.gov/condomeffectiveness/. Published 2016. Accessed May 17, 2016. 4. Centers for Disease Control and Prevention. Testing. http://www.cdc.gov/hiv/basics/testing.html/Should. Published 2016. Accessed April 27, 2016. 5. Centers for Disease Control and Prevention. Prevention benefits of HIV treatment. http://www.cdc.gov/hiv/research/biomedicalresearch/tap/index.html. Published 2016. Accessed April 27, 2016. 6. Centers for Disease Control and Prevention. HIV risk reduction tool: sharing needles or works? https://wwwn.cdc.gov/hivrisk/increased_risk/sharing_needles.html. Accessed April 27, 2016. 7. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach—second edition. http://www.who.int/hiv/pub/arv/arv-2016/en/. Published June 2016. Accessed June 27, 2016. 8. Centers for Disease Control and Prevention. Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV—United States, 2016. https://stacks.cdc.gov/view/cdc/38856. Published 2016. Accessed May 18, 2016. 9. AIDS.gov. Post-exposure prophylaxis (PEP). https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/post-exposure-prophylaxis/. Published September 21, 2015. Accessed June 1, 2016. 10. Marrazzo JM, del Rio C, Holtgrave DR, et al. HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA. 2014;312(4):390-409. doi:10.1001/jama.2014.7999.