Strategies for people with HIV infection

Until recently targeting prevention interventions to HIV positive individuals has been largely neglected. Affected communities have been understandably concerned about stigmatisation and discrimination, while those responsible for prevention have felt poorly equipped to tackle many of the key issues.

Box 16.4 Guidance for enhancing sexual health promotion and HIV prevention in minority ethnic communities

• Facilitating access to appropriate confidential adolescent and adult sexual health and HIV prevention services, including specialist services outside routine clinical settings inline with the expressed needs of the community

• Developing materials using appropriate language and images including materials appropriate for non-native English- speakers

• Early and continued sex education in schools to supplement and support provision in the home

• Assisting parents from cultures where sex in general is rarely discussed to discuss sex education

• Providing focused interventions for young boys in either school or community settings

• Prohibitive messages may be supported by some particularly older generations

• Exploiting and explaining the wider benefits of safer sex in relation to contraception and avoidance of other infections may increase the overall acceptability of messages with all audiences

• Focused work exploring assumptions made about “safe” partners and concurrent relationships in cultures where they are common

• Use of appropriate and community-specific delivery points, for example, settings appropriate to the specific culture

• Awareness of different migration, refugee and acculturation experiences between communities and between generations

• Promoting HIV testing within high-risk ethnic communities is likely to be extremely sensitive and should be treated with careful consideration and caution based on a clear understanding of the individual and community issues

Figure 16.6 Key materials should be available using appropriate language and images for minority groups and for non-native English speakers

practices to avoid infecting others. Collectively, increased survival leads to a larger pool of infected people in the community who may pass on infection and there is already evidence that new HIV infections may once again be increasing in parts of the USA.

Prevention trials specifically with those living with HIV are scarce. However, recent research and community consultation has provided indications of acceptable primary prevention approaches. Acceptable primary prevention strategies with HIV positive people include providing counselling and support in both one-to-one and small group contexts, providing specialist sexual health and STI screening services for HIV positive people, and offering social, emotional and sexual counselling support within HIV outpatient treatment services. As with other groups, interventions are more likely to achieve success if they occur in genuinely productive partnerships with leadership from the affected communities to overcome wider social prejudice and stigmatisation.