1. JORDAN E. LAKE, MD, MSC AAHU AUGUST 2015 Prevention for Positives

2. PREVENTION FOR POSITIVES? What is

3. Prevention for Positives (PWP) CDC initiative Initial Goals: increased HIV testing in medical settings increased use of new testing technologies prevention of transmission from HIV+ persons to sex and needle sharing partners prevention of perinatal transmission Now: “A holistic and system level approach to risk reduction” aimed at High Impact Prevention in the U.S.

4. Prevention for (with) Positives (PWP) PWP means helping HIV+ persons learn how to Prevent transmitting HIV to someone else Optimize self health and behaviors

5. Prevention for (with) Positives (PWP) Can you name some PWP techniques?

6. Prevention for Positives (PWP) 10 components: -linking every person living with HIV to medical care -retaining patients in care -prescribing ART to all patients -helping patients maintain adherence to treatment -providing partner services -screening for HIV risk/referring to risk reduction programs -giving referrals to other supportive services -screening for sexually transmitted infections and supplying related services -delivering appropriate reproductive health care -preventing mother-to-child transmission of HIV

7. http://www.cdc.gov/hiv/prevention/programs/pwp/index.html

8. PWP for Developing Countries http://www.who.int/bulletin/volumes/88/8/09-068213/en/

9. GETTING PATIENTS IN CARE AND KEEPING THEM THERE PWP

10. http://www.cdc.gov/hiv/prevention/programs/pwp/linkage.html

12. PREVENTING HIV WITH ART PWP

13. HPTN 052 Cohen MS et al. N Engl J Med 2011;365:493-505.

14. N Engl J Med 2000; 342:921-929

15. HIV MEETS THE “OTHER” STIs PWP

16. STIs and HIV Transmission An HIV+ person with and STI is more likely to transmit HIV through sexual contact Ulcers, inflammation, increased HIV in genital secretions 1. Wasserheit JN. 1992. Sexually Transmitted Diseases 9:61-77. 2. http://www.cdc.gov/std/hiv/stdfact-std-hiv.htm

17. STIs and HIV Transmission: Test Frequently and

18. OTHER STRATEGIES PWP

19. Risk Reduction as PWP Counseling and education regarding Sexual practices STI history Substance use Domestic violence Food and housing security Fertility desires HIV disclosure Access to services such as needle exchange, substance abuse treatment, shelters, etc.

20. Risk Reduction as PWP For your clients, which risk reduction services are most important?

21. Disclosure: Do the Right Thing

22. Disclosure: Teaching Others To Do the Right Thing Too

23. Barriers to Risk Reduction Implementation The provider/client environment has to be and feel non-judgemental Providers have to ask! Providers need time to educate and available referral services Clients have to be engaged and want to implement change

24. Barriers to Risk Reduction Implementation Providers have to ask!

25. Barriers to Risk Reduction Implementation Clients have to be engaged and want to implement change

26. The Engaged Client: Self-Management

27. http://www.treatmentactiongroup.org/tagline/2014/spring/forgotten-negatives-limits-treatment-prevention

28. PWP: It Takes a Village!

29. http://www.hivpwp.org/