1. Secondary Prevention

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

3. 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

4. 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

5. 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.

6. 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 +

7. 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,

8. 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

9. 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

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

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