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Integrating Multidimensional HIV Prevention Programs Into Healthcare Settings

From the Department of Medicine and the Institute of Human Virology of the University of Maryland School of Medicine, Baltimore, MD.

Address correspondence and reprint requests to Lydia R. Temoshok, Institute of Human Virology, University of Maryland School of Medicine, 725 W. Lombard Street, Rm. 146, Baltimore, MD 21201. E-mail: ltemoshok{at}ihv.umaryland.edu

Effective secondary prevention programs to reduce HIV transmission risk-relevant behaviors among HIV-infected individuals must go beyond the traditional, common sense prevention components to develop biomedically and epidemiologically informed behavioral interventions as part of comprehensive, integrated, multidisciplinary HIV care. Incorporating and expanding on the Serostatus Approach to Fighting the Epidemic, a five-pronged strategy set forth by the Centers for Disease Control and Prevention in 2001, we discuss recent findings from the biomedical sciences on viral and host factors that influence infectiousness to support the idea that the most proactive prevention programs will explicitly integrate biomedical interventions and approaches designed to reduce infectiousness, and thus the sexual transmission of HIV. Based on studies of emerging and spreading drug-resistant HIV variants, we have posited the potential development of biodisparity as the biological entrenchment of disparities in socioeconomic status, access to care, and HIV risk-relevant behaviors that differentially affect minorities living with HIV in the US. It is clear that creative approaches based on an expanded behavioral medicine interface with the latest HIV biomedical and epidemiological research are needed to enhance the efficacy of HIV secondary prevention.

Key Words: HIV secondary prevention • HIV prevention • HIV transmission • HIV infectiousness • biodisparity • sexually transmitted diseases

Abbreviations: AIDS = acquired immune deficiency syndrome; ART = antiretroviral therapy; CDC = Centers for Disease Control and Prevention; FDA = Food and Drug Administration; HIV = human immunodeficiency virus; HSV-2 = herpes simplex virus 2 (genital herpes); N-9 = Nonoxynol-9; PWP = prevention with positives; SAFE = Serostatus Approach to Fighting the Epidemic; STD = sexually transmitted disease.

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