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Rural Health Information Hub

HIV Treatment as Prevention

Prevention efforts can be designed to reduce HIV incidence by engaging people living with HIV as active participants in the interventions. Treatment as prevention is a strategy that uses antiretroviral treatment (ART) to reduce the risk of transmitting HIV. People with HIV are encouraged to begin ART as soon as possible or within 90 days of diagnosis as well as make other behavioral changes in order to reduce their viral load and limit transmission of the virus. Prevention programs that focus efforts on people living with HIV may also focus on social and structural issues that can affect treatment, including a lack of health insurance, unstable housing, or substance use.

While interventions that aim to reduce risky behaviors are still proposed as important models for preventing new HIV cases, the Centers for Disease Control and Prevention (CDC) and other federal and local agencies emphasize that one of the key forms of preventing new HIV cases is connecting individuals with HIV to quality treatment. People with HIV who take ART as directed by their medical provider and achieve viral suppression will not pass HIV to sexual partners who are HIV-negative. Treatment as prevention is such an effective strategy that a campaign was formed to encourage awareness, “Undetectable=Untransmittable.”

Examples of HIV Treatment as Prevention Focused on People Living with HIV:

  • Maine Health Equity Alliance organizes two different programs designed to support residents of Maine living with HIV/AIDS. The first initiative is a support group, which connects members to valuable resources to help them live a healthy life, keep them engaged in care, and also aims to help members build stronger ties within their communities. The other initiative involves connecting people to peers who are also living with HIV. Peers are able to link each other with valuable HIV resources and treatment options, while also providing emotional support.
  • Chattanooga CARES is implementing the Healthy Relationships intervention, which is a small-group intervention for people living with HIV/AIDS that encourages skill building exercises for them to become more independent and develop healthy behaviors. This program, which is listed in the CDC Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention, uses principles from the Social Cognitive Theory of behavior change during each of the five sessions. Healthy Relationships aims to help develop positive relationship skills and improve self-efficacy. The intervention incorporates role playing and videoconferencing to engage HIV-positive individuals in conversations and scenarios that can help improve their relationships with partners and other people in the community. The intervention encourages and demonstrates ways for participants to disclose their status to partners and how to make less risky decisions. Preliminary findings from a study about Healthy Relationships showed that it had “promising evidence for effectiveness.”

Considerations for Implementation

People living with HIV/AIDS in rural communities face unique challenges and can experience barriers to accessing healthcare. Stigma, isolation, lack of transportation, poverty, and other factors can all interfere with people engaging in treatment in a timely manner after a diagnosis.

Retention in care and adherence to antiretroviral therapy is a central element of prevention for people living with HIV, since a reduced viral load is a key strategy for preventing HIV transmission to partners. Finding ways to improve access to healthcare services and strategies for patient retention can improve the likelihood that people living with HIV will also engage in prevention activities.

To address these challenges, some rural communities choose to implement prevention programs in clinical settings to engage people while they are receiving care with providers they trust. Some communities also use case management and patient navigation to try to improve retention. Implementing prevention interventions in clinical settings can be challenging and selecting an appropriate intervention depends on the clinic's environment and population served.

Rural programs implementing prevention interventions with people who are living with HIV should consider working with community organizations that currently organize support groups around different issues in the community. This might be a helpful initial strategy for developing a program. Partnerships with other organizations can help to promote the program through more diverse channels, which could potentially also lead to higher rates of participation and retention.

Staff and peer leaders involved in prevention programs should be trained in communications strategies and methods relevant to discussing HIV/AIDS issues. Cultural competency and sensitivity are crucial when working with people living with HIV. Many prevention interventions are based on principles of behavior change and can take time to have an impact.

Resources to Learn More

Recommendations for HIV Prevention with Adults and Adolescents with HIV in the United States, 2014
Offers guidance and implementation resources for clinical and non-clinical providers of HIV care, health policy, and program planning services, including health departments. Covers all aspects of HIV prevention, including transmission dynamics, issues in retention in care and medication adherence, reproductive healthcare for at-risk population, and program monitoring and evaluation.
Organization(s): Centers for Disease Control and Prevention (CDC), Division of HIV/AIDS Prevention
Date: 12/2016