Secondary Prevention

Basis for Secondary Prevention STDs Drug Resistance HIV super-infection Mother to child transmission Hepatitis C Hepatitis B

Condoms Protect ? 98.5% risk reduction /single act with infected partner 14% failure with 10 acts 26% failure for 20 acts 37% failure for 30 acts Fitch STD 2002, Mann STD 2002

Condoms are not Perfect Slippage 0.8% (5y experience) Breakage 0.7% (5y experience) Pregnancy Risk 6% (< 2 y experience) 3.6% (>4y experience) Messiah AJPH 1997

Sexual Behavior Risk Fisher and Fisher, Options Project 51% of HIV+ clinic participants engaged in sexual activity in pat 3 mos. 52/496 HIV + participants had risky vaginal or anal sex with 197 partners in past 3 mos.

Drug Use Risk Fisher and Fisher, Options Project 35% of IDUs who injected in last month borrowed or lent dirty works to: 75 HIV – 113 HIV unknown 65 HIV +

Sexual Risk 50-90% HIV+ remain sexually active after diagnosis 20-60% HIV + and sexually active don’t use condoms consistently Darrow et. al 1998, Wilson 1999, Deren 1998, Fisher, 1999,

Interventions to Reduce Sexual Risk Behaviors Population HIV + Drug users Women HIV + MSM Increased Condom use Decreased sexual partners 26% decrease in unprotected sex Risk Reduction 0.81 (OR) 50% risk reduction at 6mos 0.69 (OR) 0.61(OR) 0.74 (OR) Shain STD 2002, Semaan JAIDS 2002, Johnson JAIDS 2002

Mentally Ill Cognitive-behavioral HIV risk reduction Increased condom use Higher percentage of intercourse occasions with condoms More positive attitudes toward condoms Behavior change present at 3,6,9 mos. Behavior change diminished by 12 mos. Otto-Salag Com Mental Health J 2001

Types of interventions Social Structural Behavioral Motivational Interviewing Counseling Education Risk reduction Risk consequences

Approaches to Harm Reduction Multiple attempts Longitudinal follow up Patient buy-in Multidisciplinary Consistent messages Non judgmental