By Wezi Tjaronda
The increasing availability of HIV treatment provides an opportunity to reach a large number of infected persons with prevention messages and interventions, Dr Pamela Bachanas has said.
Dr Bachanas, Behavioural Change Communication Team Leader, HIV Prevention Branch, Centre for Disease Control and Prevention, was speaking this week during a meeting of the HIV Prevention in Care and Treatment Settings project, which ended in Windhoek on Friday.
The project is an initiative involving Namibia, Kenya and Tanzania and is part of the US President’s Emergency Plan for AIDS Relief (PEPFAR).
She said although there are impressive figures of 2.5 million people in Sub-Saharan Africa who are on treatment, 2007 recorded 2.5 million people that were newly infected with the virus and would eventually need ARVs.
For countries to have a significant impact on slowing the epidemic, she said prevention efforts should be directed at individuals living with HIV who can transmit the disease.
“Traditional focus of prevention has been on HIV negative individuals,” she said.
At present, only a few HIV positive individuals access prevention services from community and faith based organisations, which have most of the programmes designed for HIV negative individuals.
Positive prevention goals include reducing sexual transmission of HIV to partners, identifying partners/family for care and treatment, reducing patients’ risk of acquiring new infections, reducing unintended pregnancies, reducing alcohol use that contributes to high risk transmission behaviour and poor adherence and also reducing viral load through increasing adherence to care and treatment.
To achieve these goals, Bachanas said services should include partner testing and assistance with disclosure, sexual risk reduction for STI management to be integrated in HIV clinics, family planning in HIV treatment and care clinics and also ARV adherence and counselling.
Bachanas said health care providers in HIV clinic settings met with patients regularly and could assist to deliver consistent, targeted prevention messages and strategies during routine visits.
Providers were also considered authority figures and trusted sources of health information, she said.
“For any disease, preventive information on infection control is regarded as quality standard of care,” she added.
Considering the clinic burden and complexity of patients’ needs, many patients need more in-depth counselling on prevention issues such as disclosure and alcohol use, while incorporating counsellors and people living with HIV/AIDS into clinic settings is essential for a comprehensive prevention programme.
On family planning, she said many women on ARVs resumed sexual activity and have unintended pregnancies. For these, preventing unintended pregnancy in HIV+ women who do not want children could avert the need for and costs associated with Prevention of Mother to Child Prevention Treatment (PMTCT) care for HIV+ children and support for orphans.
However, women that wanted children and are on treatment require counselling on safe timing of pregnancy and referrals to PMTCT.
Many HIV+ persons remain sexually active, because with health restored on ARV, sexual activity increases. Yet, there have been reports of low rates of condom use, especially in stable relationships.
In Kenya for instance, almost half of ARV patients reported no or inconsistent condom use and many reported having casual partners and compared to these ARV patients, patients on preventive therapy reported significantly less consistent condom use and more casual partners.
According to Bachanas, what is needed in this case are brief messages about abstaining or being faithful, reducing the number of partners and using condoms during every sexual encounter, as well as the distribution of condoms.