Why is positive prevention needed now?

Why is positive prevention needed
now?
Since HIV made its debut on the
international stage over 25 years ago,
much has been learnt about prevention.
Knowledge about HIV transmission and
the role of key interventions to prevent
HIV transmission from mother-to-child
and harm reduction initiatives for
injecting drug users have dramatically
altered the prevention landscape.
However, in the face of increased
treatment and the key to sustained
behaviour change(s) remaining largely
elusive, HIV prevention fatigue is a
reality which has not been adequately
addressed. The weariness of both the
“post-AIDS” generation for whom past
hard won battles have little meaning as
they explore their sexuality and for those
who have reaped the rewards of
antiretroviral therapy are realities that
our prevention efforts need to address
more boldly.
‘Traditional’ prevention efforts have
largely targeted those who are HIVnegative,
and obviously this is crucial,
yet it ignores the needs, and important
role, of those who are HIV positive. The
assumption that knowledge of HIV
status alone will ensure sustained safer
sex practice has been called into
question by the increasing number of
new infections in key populations where
HIV had appeared to have stabilized.
The HIV prevention agenda needs to
keep pace with these new and dynamic
demands of the epidemic – and this
includes responding to the reality of
treatment access, the increasing
number of serodiscordant relationships
and the importance of addressing the
specific prevention needs of people
living with HIV. Encouraging and
supporting people living with HIV to live
‘positively’ includes a strong recognition
that issues of love, life and intimacy are
part of their reality.
HIV-positive people – the vast majority
of whom are unaware of their status -
are the nexus for future infections and
to exclude them from dedicated
prevention efforts is not conducive to
successful global prevention. By
building on the lessons that have been
learnt about strengthening the links
between HIV prevention, and AIDS
treatment, care and support into a
seamless continuum and about the
imperative of a human rights-based
approach towards HIV, the addition of
‘positive prevention’ initiatives will create
cohesiveness to ensure that the sum
of the parts is greater than each
individual component.
What is positive prevention?
Positive prevention can be defined2 as
a set of actions that help people living
with HIV to:
􀂄 protect their sexual health;
􀂄 avoid other sexually transmitted
infections;
􀂄 delay HIV and AIDS disease
progression; and
􀂄 avoid transmitting HIV to others.Positive prevention is based on the
realities and perspectives of people
living with HIV and it acknowledges that
every individual has a right to a
productive, satisfying and enjoyable
sexual (and reproductive) life. This
necessitates the development of explicit
information that can inform the choices
that people living with HIV (and their
sexual and recreational partners) make.
Ownership of positive prevention
approaches depend and rely upon
individual action.