For HIV-negative persons or persons of unknown HIV serostatus

Clinician Training
Clinicians can prepare themselves to deliver HIV prevention messages and brief behavioral interventions to their patients by 1) developing strategies for incorporating HIV risk-reduction interventions into patients’ clinic visits (159); 2) obtaining training on speaking with patients about sex and drug-use behaviors and on giving explanations in simple, everyday language (68,87,160,161); 3) becoming familiar with interventions that have demonstrated effectiveness (162); 4) becoming familiar with the underlying causes of and concerns related to risk behaviors among HIV-infected पेरसोंस
Topics that can be successfully addressed by clinicians and clinic support staff:
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lack of knowledge about HIV transmission risks;
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misconceptions about risk of specific types of sexual and drug-use practices;
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misconceptions about viral load and transmission of HIV;
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how to disclose HIV-seropositive status to a sex partner, family member, or friend;
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importance of using condoms or not exchanging fluids with partners;
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ways to reduce number of sex or drug partners;
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ways to keep condoms accessible;
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ways to remember to use condoms;
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how to persuade a sex partner to use a condom;
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ways to obtain support (e.g., emotional, financial) from family, friends, and lovers;
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ways to clean/disinfect injection equipment;
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ways to obtain clean needles;
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ways to avoid sharing injection equipment; or
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ways to deal with mild psychological distress stemming from situational circumstances.
Issues that might need referral to outside agencies
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need for intensive HIV prevention intervention;
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excessive use of alcohol or recreational drug use;
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drug addiction, including injection drug use;
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depression, anger, guilt, fear, or other mental health needs;
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need for social support;
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sexual compulsivity;
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sexual or physical abuse (victim or perpetrator);
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desire to have children, contraceptive counseling;
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housing or transportation needs;
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nutritional needs;
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financial emergencies;
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child custody, parole, or other legal matters; or
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insurance coverage।
with community resources that address risk reduction. Free training on risk screening and prevention can be obtained at CDC-funded STD/HIV Prevention Training Centers (http:// depts.washington.edu/nnptc) and HRSA-funded AIDS Education and Training Centers (http://www.aids-ed.org), which also offer continuing medical education credit for this training. Ongoing training will help clinicians refine their counseling skills as well as keep current with prevention concerns at the community level, thus increasing their ability to appropriately counsel and provide support to patients.
BOX 4. Examples of messages that should be communicated to drug users who continue to inject*
Persons who inject drugs should be regularly counseled to do the following:
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Stop using and injecting drugs.
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Enter and complete substance abuse treatment, including relapse prevention.
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Take the following steps to reduce personal and public health risks, if they continue to inject drugs:
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Never reuse or share syringes, water, or drug preparation equipment.
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Use only syringes obtained from a reliable source (e.g., pharmacies).
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Use a new, sterile syringe to prepare and inject drugs.†
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If possible, use sterile water to prepare drugs; otherwise, use clean water from a reliable source (such as fresh tap water).
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Use a new or disinfected container (cooker) and a new filter (cotton) to prepare drugs.
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Clean the injection site with a new alcohol swab before injection.
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Safely dispose of syringes after one use.
In addition, drug users should be provided information regarding how to prevent HIV transmission through sexual contact and, for women, information regarding reducing the risk of mother-to-infant HIV transmission.
* Source: US Department of Health and Human Services. Medical advice for persons who inject illicit drugs. HIV Prevention Bulletin. CDC; Health Resources and Services Administration; National Institute on Drug Abuse, National Institutes of Health; Center for Substance Abuse and Mental Health Services Administration. May 1997. Available at http://www.cdc.gov/idu/pubs/hiv_prev.htm.
† If new, sterile syringes and other drug preparation and injection equipment are not available, previously used equipment should be boiled or disinfected with bleach by using the methods recommended by CDC (Source: CDC National Prevention Information Network. HIV connect. Vol. 11, No.8. Available at http:// www.cdcnpin.org).
Ongoing Delivery of Prevention Messages
Prevention messages can be reinforced by subsequent longer or more intensive interventions in clinic or office environments by nurses, social workers, or health educators. Advantages of a multidisciplinary approach are that skill sets vary among staff members from various disciplines and that a patient may be more receptive to discussing prevention-related issues with one team member than with another. For HIV-negative persons or persons of unknown HIV serostatus, randomized controlled trials provide strong evidence for the efficacy of short, one- or two-session interventions (164–170) and for longer or multisession interventions in clinics for individuals and groups (164,171–173). For example, for persons who continue to engage in risky behaviors, CDC recommends client-centered counseling, a specific model of HIV prevention counseling