HIV Infection Prevention

The Centers for Disease Control and Prevention (CDC) estimates that approximately 1.2 million persons are living with HIV in the United States.* The number of HIV infected U.S. residents is expected to increase over time due in part to the following:

On July 13. 2010 the U.S. initiated a national plan to significantly reduce new HIV infections by 2015. "The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socioeconomic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination." The National HIV/AIDS Strategy has set forth the following goals and action plan:

Action Plan

Reducing New HIV infections
• By 2015, lower the annual number of new infections by 25%.
• Reduce the HIV transmission rate, by 30%.
• By 2015, increase the percentage of people living with HIV who know their serostatus from79% to 90%

Reducing New HIV Infections
• Intensify HIV prevention efforts in the communities where HIV is most heavily concentrated
• Expand targeted efforts to prevent HIV infection using a combination of effective, evidence-based approaches
• Educate all Americans about HIV epidemic and the value of early testing, diagnosis and treatment.

Increasing Access to Care and Improving Health Outcomes for People Living with HIV
• By 2015, increase the proportion of newly diagnosed
patients linked to clinical care within three months of their HIV diagnosis from 65% to 85%.
• By 2015, increase the proportion of Ryan White HIV/AIDS Program clients who are in continuous care (at least 2 visits for routine HIV medical care in 12 months at least 3 months apart) from 73% to 80%.
• By 2015, increase the number of Ryan White clients with permanent housing from 82% to 86%

Increasing Access to Care and Improving Health Outcomes for People Living with HIV
• Establish a seamless system to immediately link people to continuous and coordinated quality care when they learn they are infected with HIV
• Take deliberate steps to increase the number and diversity
of available providers of clinical care and related services for
people living with HIV
• Support people living with HIV with co-occurring health conditions and those who have challenges meeting their basic needs, such as housing
Reducing HIV-Related Health Disparities
• Improve access to prevention and care services for all Americans.
• By 2015, increase the proportion of HIV diagnosed gay and bisexual men with undetectable viral load by 20%.
• By 2015, increase the proportion of HIV diagnosed Blacks with undetectable viral load by 20%.
• By 2015, increase the proportion of HIV diagnosed Latinos with undetectable viral load by 20%.
Reducing HIV-Related Disparities and Health Inequities
• Reduce HIV-related mortality in communities at high risk for HIV infection
• Adopt community-level approaches to reduce HIV infection in high-risk communities
• Reduce stigma and discrimination against people living with HIV
  Achieving a More Coordinated National Response to the HIV Epidemic
• Increase the coordination of HIV programs across the Federal government and between Federal agencies and state, territorial, tribal, and local governments
• Develop improved mechanisms to monitor and report on progress toward achieving national goals

HIV Testing + HIV Medical Treatment+ Prevention Counseling = Fewer HIV infections, better health and longer life.

Effective HIV Prevention Strategies:

Recently, the 1988 restriction on federal funding for NEPs was lifted when the U.S. Surgeon General determined that NEPs are a form of treatment. Given appropriate leadership and resources, creation of NEPS in urban American HIV hot spots should duplicate the success experienced in cities like Vancouver, BC. Unfortunately many states, including Florida, continue to restrict access to syringes by enforcing “drug paraphernalia” laws, and regulating the purchase and sale of syringes in pharmacies.

Combining well managed needle-exchange programs, condom distribution and safe practice counseling offers a real opportunity to reduce HIV transmission. Where NEPs are thwarted, education efforts must to be made to IDUs not to share needles, cotton, syringe, or cookers - all of which may be contaminated with blood. People need to be encouraged to use new needles and syringes or to sanitize their injection sets with full strength bleach and rinse thoroughly with water before each use.

Substance abuse programs: The United States has approximately 1.5 million injection drug users and many additional people who use other drugs, such as cocaine, crack, or alcohol. However, there are only about one-half million drug treatment slots available. Therefore, meeting the needs of HIV positive people who suffer from substance abuse presents a particular challenge.

Abstinence: Abstinence is said to be the only 100% effective method of preventing sexually transmitted HIV infection. Abstinence is an act of self-denial which implies capacity to consent to an act and the psychological, physical and economic independence to refuse to partake. Unfortunately, abstinence is not an option equally available to all persons:

Universal/Standard precautions: Universal precautions are mandated by OSHA for health care workers, as a way to prevent occupational exposure to blood borne pathogens, e.g. HIV, Hepatitis A, B, C, Staph, Strep, Syphillis, TB, etc.

Instant feedback:

If needle exchange is not available, injection drug users need to be taught to sanitize their with full-strength bleach and rinse with water before use.

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