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• W2079553609 abstract "Data from the United States suggest that approximately 60% of people living with HIV/AIDS (PLWHA) are aware of their HIV status. These data contrast with Brazil, where a report from 2001 estimates that 600,000 men and women are living with HIV (age range: 15–49 years), of whom 149,000 (in 2003) receive treatment. 1 The estimate for persons living with HIV (PWHIV) who are aware of their status is 215,000 (approximately 35%; D. Barreira, MD, PNSTD-AIDS, private communication). This trend toward low proportions of persons who know their serostatus has been observed in many countries in the world. So, although prevention with PLWHA who know their serostatus is certainly worthy of the attention devoted by this issue as well as by resources allocated in the United States, this strategy may not always act on the “core” of the epidemic, at least in countries where prevention efforts then miss the majority of persons who do not know they have HIV. In this commentary, I highlight some important aspects of the focus of prevention on HIV-positive persons, especially in international settings. First, we must remember that many PLWHA were most likely aware of the threat of HIV and exposed to preventive messages before they became infected; in a sense, this means that these approaches failed for them. Moreover, it is also likely that the individual and social characteristics of their vulnerability still persist in their lives. Some people do not easily overcome the news of an HIV diagnosis, even in places where there is access to antiretroviral (ARV) therapies. Certainly, some people reshape many aspects of their lives after learning their HIV diagnosis and make positive changes such as risk reduction and being adherent to therapy. The question remains, however, as to whether HIV infection is such an important additional circumstance that it would be a logical strategy to rely on delivering the same kinds of prevention messages that had already failed for this person. It has been argued that too much focus on prevention with positive persons is blaming these individuals for new infections; I argue that this is an insufficient framework for prevention because it continues to ignore the social contexts that favor infections. Did they have easy and affordable access to preventive means such as condoms or syringes? Did they live in neighborhoods where disadvantages, discrimination, and a lack of social capital provide them with few healthy alternatives? In my opinion, criminalization of HIV transmission should also be interpreted within this frame; what kind of a barrier does this issue present for eliminating stigmatization from the prevention and treatment process? Second, it now seems clearer than ever that it is important to listen carefully to persons who have become HIV-positive and try to see where preventive activities failed for them so as to provide new approaches tailored for others like them. I note a positive trend in that several of the studies in this issue seem to have drawn on the expertise of the consumer community for new directions. For example, in an article in this issue on an integrated behavioral intervention with HIV-positive injection drug users to address medical care," @default.
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• W2079553609 date "2004-10-01" @default.
• W2079553609 modified "2023-09-25" @default.
• W2079553609 title "Prevention With People With HIV/AIDS" @default.
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• W2079553609 doi "https://doi.org/10.1097/01.qai.0000140615.74510.78" @default.
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