How can we, as practitioners, prevent HIV infection from occurring? Recently [October 2011] I had the opportunity to hear Dr. Michael Saag from the University of Alabama at Birmingham present during the Infectious Diseases Society of America (IDSA) Annual conference in Boston on “30 Years of HIV/AIDS – Where We Have Been and Where Are We Going.” This wonderful historical review included a brief discussion of HIV prevention measures and focused on recent microbicides and pre-exposure prophylaxis data. His presentation caused me to reflect on past recommendations from the CDC, NIH, and HIVMA/IDSA in 2003 regarding the incorporation of HIV prevention into the medical care of persons living with HIV. This strategy involves obtaining a sexual history, identifying risky behaviors that may increase their risk of STD infection, and screening sexually active HIV-positive individuals for sexually transmissible infections at least annually (or more frequently if their risk is significant) as part of their ongoing clinical management. We understand that an individual's untreated STD infection(s) increases their chance of acquiring HIV, and conversely, an HIV-positive individual with an ulcerative or inflammatory STD is more likely to transmit HIV in genital secretions or direct sexual contact.
What are some ways to get MSM into medical care? This is a frequently asked question and one with a very complicated answer. Researchers, community advocates, and medical providers have made serious inroads into identifying and understanding the barriers to accessing medical care for MSM. One key barrier that is often noted anecdotally and in literature relates to providing culturally competent care.
How can mapping the HIV epidemic help healthcare providers talk to patients about getting tested?
An estimated one in five individuals living with HIV in the United States don’t know they are infected, according to the Centers for Disease Control and Prevention (CDC). CDC recommends routine HIV screening among persons aged 13-64, but many individuals, due to the lingering stigma around the disease, are hesitant to talk about HIV with their doctors or to ask to be tested. Healthcare providers often do not test patients because they perceive that the patients do not fit a risk profile or because the providers are not comfortable assessing and discussing HIV risk behaviors.