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HIV Secondary Prevention

Developed by the
PWA/PWHIV Advisory Committee
of the NYC and NYS HIV Prevention Planning Groups

Revised 1999

Due to ongoing trends in the HIV epidemic, and realizing the necessity of reducing disease progression and mortality and to eliminate acquiring other diseases, it is essential that all communities concerned arrive at a comprehensive definition of secondary prevention.

Definition

Secondary prevention in general refers to early detection and prompt treatment of disease. With such measures, it is sometimes possible to either cure disease or slow its progression, prevent complications, limit disability, and reverse communicability of infectious disease.

  • Secondary prevention refers to preventing the activation of latent infections and promoting optimal health in HIV-Infected individuals.
  • Potential benefits of secondary prevention include arresting or slowing HIV disease progression, preventing complications, limiting disability, and reducing the spread of HIV. (HIV and Primary Care, 1998)

On a community basis, early identification and treatment of persons with infectious disease (e.g., sexually transmitted infections) may protect others from acquiring infection, and thus provide at once secondary prevention for the infected individuals and primary prevention for their potential contacts.

Despite well-intended primary prevention efforts and interventions, the HIV infection rate in the general population continues to rise. Accordingly, secondary prevention becomes a critical element of the continuum of HIV prevention and care services, capable of improving quality of health and reducing morbidity.

Elements of HIV Secondary Prevention

There are many identified key elements of a comprehensive secondary prevention plan relevant to HIV/AIDS. Those, which follow, have been identified as necessary components by the PWA/PWHIV Advisory Committee of the NYC and NYS HIV Prevention Planning Groups. These components have not been prioritized, nor is the listing exhaustive; rather, they should be viewed as components of a comprehensive secondary prevention services delivery system.

Delivery of each element listed below must be linguistically and developmentally appropriate.

  1. Culturally sensitive, linguistically and developmentally appropriate counseling, testing, referral and partner/contact notification.
  2. Psychosocial Support and Mental Health Services
  3. Peer Interventions including support, advocacy and trainings for access to secondary prevention services.
    • Includes referral to primary care and supportive medical and non-medical services and access to transportation, housing, food, and child care, skills-building for self-advocacy, negotiating social service networks, ongoing treatment and nutrition education and participating fully in treatment decisions
  4. Harm Reduction
  5. Timely healthcare maintenance
  6. Treatment Education
  7. Nutrition and Health Promotion for People Living with HIV
  8. Preventing Sexually Transmitted Diseases
  9. Alternative, Adjunct and Complementary Therapies

Delivery of Services

Studies have shown that, to be effective, any current or planned delivery of these services must reach those persons infected/affected:

  • in a nonjudgmental way, ever sensitive to culturally distinct and evolving quality of life needs
  • by offering services as diverse and rich as possible
  • by engendering and fostering pro-active ongoing education for both consumer and caregiver
  • reevaluating the needs of the consumer on an ongoing basis with consideration given to emerging needs and quality assurance
  • treating HIV as a chronic, rather than terminal illness
  • capitalizing on the goal of helping persons in the continuum of living with, HIV and AIDS by providing access and linkage to full services for persons at all levels of the HIV/AIDS spectrum
  • developing a partnering relationship between clients/consumers, significant others and care providers as active participants in an informed decision-making process.

Policy and Planning

Realizing that a comprehensive secondary prevention plan crosscuts public health programs and funding streams at the federal, state, local and private levels, it is essential that strategic and operational planning and decision-making regarding the delivery of the aforementioned services be coordinated and linked. Specifically, institutional barriers that have historically fragmented the prevention continuum, health care and clinical research must be acknowledged, with a process developed to link those programs and services, which support secondary prevention to the delivery of those services. Moreover, CDC and Ryan White funding streams must allow for flexibility in promoting the continuum of secondary prevention services.

Leadership

People living with HIV and AIDS should be involved in the design, implementation and evaluation of secondary prevention strategies at all levels, including, but not limited to advisory boards, leadership training institutes, focus groups, peer training institutes. Community-based organizations and AIDS service organizations should assume leadership roles in promoting secondary prevention. Healthcare facilities should work closely with community-based organizations to develop and implement secondary prevention strategies appropriate to targeted populations.

Funding

CDC funding streams should be flexible enough to promote increased access to secondary prevention services, especially in rural areas of New York State and with identified underserved populations most impacted by the epidemic. Ongoing evaluation of resource allocation should be conducted to ensure that funding is representative of ever-shifting present and emerging needs in the spectrum of secondary prevention within the continuum of HIV/AIDS. This commitment is best realized and demonstrated by those service providers who not only encourage and support the input of client/consumer advisory groups, but promote consumer participation in program design, delivery and evaluation.