Präventionsstrategien zur Eindämmung der HIV-Epidemie

Erfolge, Probleme und Perspektiven
Leitthema: HIV: Prävention und Aufklärung
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Zusammenfassung

Nach der Erstbeschreibung des Krankheitsbildes AIDS und der Entdeckung von HIV Anfang der 1980er-Jahre entwickelte sich eine heftige Debatte darüber, mit welchen Mitteln eine Ausbreitung von HIV verhindert werden könnte. In allen westlichen Industriestaaten setzte sich schließlich eine Präventionsstrategie durch, deren wesentliche Pfeiler Aufklärung zu Übertragungswegen, die Werbung für Kondomgebrauch und schadensminimierende Ansätze bei Drogengebrauchern waren. Der relative Erfolg dieser Strategie in den westlichen Industriestaaten, in denen eine Ausbreitung der Epidemie in der Bevölkerung weitgehend verhindert werden konnte, schien ihr Recht zu geben. In den meisten Entwicklungsländern und in den Nachfolgestaaten der ehemaligen Sowjetunion blieben die Präventionserfolge dagegen deutlich bescheidener. Die Gründe dafür sind wahrscheinlich vielfältig. Seit dem Jahrtausendwechsel mehren sich in den westlichen Industriestaaten die Anzeichen dafür, dass zumindest in einer Hauptbetroffenengruppe, den homosexuellen Männern, Risikoverhalten und HIV-Neudiagnosen wieder ansteigen. Dieses mitunter auch als Krise oder gar Versagen der bisherigen Präventionsstrategie bezeichnete Phänomen wird häufig mit der verbesserten Behandelbarkeit der HIV-Infektion in Verbindung gebracht, wobei aber umstritten ist, wie und warum diese das Risikoverhalten beeinflusst und wie Präventionsstrategien verändert oder angepasst werden müssen.

Schlüsselwörter

HIV-Prävention Kondome HIV-Serodiskordanz Barebacking Prävention durch antiretrovirale Therapie 

Prevention strategies to control the HIV epidemic. Successes, problems, and perspectives

Abstract

After the recognition of AIDS as a new disease entity and isolation of HIV as the causative agent in the early 1980s, a controversial debate about adequate measures to reduce the spread of HIV developed. In all developed countries a strategy based on education about modes of HIV transmission, condom promotion and harm reduction approaches to intravenous drug use finally succeeded and became instrumental for the relative containment of HIV within most at risk populations. However, in most developing countries as well as in the countries of Eastern Europe, the success of HIV pre vention remained limited for various reasons. In addition, for several years now, in the western developed countries sexual risk behaviour, newly diagnosed HIV infections, and the incidence of various other sexually transmitted infections seem to re-increase, especially among men who have sex with men (MSM). These increases coincide with a dramatic improvement of therapeutic options for the treatment of HIV infection. The relationship between improvement of therapy and changes in sexual risk behaviour has to be further defined. It is hypothesized that HIV serosorting as a predominant risk management strategy among MSM results in an accumulation of health risks in the HIV-positive MSM population. In addition to and beyond established condom promotion, additional biomedical approaches to reduce transmissibility and susceptibility for HIV will be necessary to regain control of the spread of HIV in highly sexually active populations.

Keywords

HIV prevention Condom HIV serodiscordance Barebacking Antiretroviral treatment as preventive tool 

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Literatur

  1. 1.
    Pilcher CD, Shugars DC, Fiscus SA et al. (2001) HIV in body fluids during primary HIV infection: implications for pathogenesis, treatment and public health. AIDS 15:837–845PubMedCrossRefGoogle Scholar
  2. 2.
    Coombs RW, Reichelderfer PS, Landay AL (2003) Recent observations on HIV type-1 infection in the genital tract of men and women. AIDS 17:455–480PubMedCrossRefGoogle Scholar
  3. 3.
    Rottingen JA, Cameron DW, Garnett GP (2001) A systematic review of the epidemiologic interactions between classic sexually transmitted diseases and HIV. Sex Transm Dis 28:579–596PubMedCrossRefGoogle Scholar
  4. 4.
    Cohen MS, Pilcher CD (2005) Amplified HIV transmission and new approaches to HIV prevention. J Infect Dis 191:1391–1393PubMedCrossRefGoogle Scholar
  5. 5.
    Wawer MJ, Gray RH, Sewankambo NK et al. (2005) Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. J Infect Dis 191:1403–1409PubMedCrossRefGoogle Scholar
  6. 6.
    Granich R, Jacobs B, Mermin J, Pont A (1995) Cuba's national AIDS program. The first decade. West J Med 163:139–144PubMedGoogle Scholar
  7. 7.
    Hansen H, Groce NE (2001) From quarantine to condoms: shifting policies and problems of HIV control in Cuba. Med Anthropol 19:259–292PubMedCrossRefGoogle Scholar
  8. 8.
    Gruskin S, Tarantola D (2001) HIV/AIDS and human rights revisited. Can HIV AIDS Policy Law Rev 6(1–2):24–29PubMedGoogle Scholar
  9. 9.
    Friedman SR, Cooper HL, Tempalski B et al. (2006) Relationships of deterrence and law enforcement to drug-related harms among drug injectors in US metropolitan areas. AIDS, Jan 2; 20(1):93–99PubMedGoogle Scholar
  10. 10.
    Tierney TW (1992) Criminalizing the sexual transmission of HIV: an international analysis. Hastings Int Comp Law Rev. Spring 15(3):475–513Google Scholar
  11. 11.
    Marston C, King E (2006) Factors that shape young people´s sexual behaviour: a systematic review. Lancet 368:1581–1586PubMedCrossRefGoogle Scholar
  12. 12.
    Crepaz N, Marks G (2002) Towards an understanding of sexual risk behaviour in people living with HIV: a review of social, psychological, and medical findings. AIDS 16:135–149PubMedCrossRefGoogle Scholar
  13. 13.
    Wodak A, Cooney A (2005) Effectiveness of sterile needle and syringe programmes. Int J Drug Policy 16S:S31–S44CrossRefGoogle Scholar
  14. 14.
    Emmanuelli J, Desenclos JC (2005) Harm reduction interventions, behaviours and associated health outcomes in France, 1996–2003. Addiction 100:1690–1700PubMedCrossRefGoogle Scholar
  15. 15.
    Kippax S, Race K (2003) Sustaining safe practice: twenty years on. Social Sci Med 57:1–12CrossRefGoogle Scholar
  16. 16.
    Ellis S, Barnett-Page E, Morgan A et al. (2003) HIV prevention: a review of reviews assessing the effectiveness of interventions to reduce the risk of sexual transmission. Health Development Agency, MarchGoogle Scholar
  17. 17.
    Xiridou M, Geskus R, deWit J et al. (2003) The contribution of steady and casual partnerships to the incidence of HIV infection among homosexual men in Amsterdam. AIDS 17:1029–1038PubMedCrossRefGoogle Scholar
  18. 18.
    Lingappa J, Kiarie J, Were E et al. (2006) Prevalence of HIV-discordance among heterosexual couples in Eastern and Southern Africa. Abstr. International AIDS Conference, TorontoGoogle Scholar
  19. 19.
    The Monitor (Kampala) (2006) Uganda: Married couples top HIV infection rates. URL: http://allafrica.com (accessed Dec. 18)Google Scholar
  20. 20.
    Grinstead OA, Gregorich SE, Choi KH et al. (2001) Positive and negative life events after counselling and testing: the Voluntary HIV-1 Counselling and Testing Efficacy Study. AIDS 15:1045–1052PubMedCrossRefGoogle Scholar
  21. 21.
    Garbus L, Marseille EA, Sewankambo NK et al. (2004) Beyond ABC: understanding key contextual elements of HIV prevalence decline and future challenges in Uganda. Abstr. MoPeE4019 International AIDS Conference, BangkokGoogle Scholar
  22. 22.
    Tumwesigye NM, Madise NJ, Holmes DJ (2004) Patterns of condom use and abstinence among unmarried youth age 15–24 in Uganda: evidence from 1995 and 2000/1 UDHS female data. Abstr. TuPeC4781 International AIDS Conference, BangkokGoogle Scholar
  23. 23.
    Mbulaiteye SM, Mahe C, Whitworth JAG et al. (2002) Declining HIV-1 incidence and associated prevalence over 10 years in a rural population in south-west Uganda: a cohort study. Lancet 360:41–46PubMedCrossRefGoogle Scholar
  24. 24.
    Central and Eastern European Harm Reduction Network: Sex work, HIV/AIDS, and human rights. July 2005Google Scholar
  25. 25.
    Hallfors DD, Iritani BJ, Miller WC, Bauer DJ (2007) Sexual and drug behavior patterns and HIV/STD racial disparities: the need for new directions. Am J Public Health 97:125–132PubMedCrossRefGoogle Scholar
  26. 26.
    Schneider MF, Gange SJ, Williams CM et al. (2005) Patterns of the hazard of death after AIDS through the evolution of antiretroviral therapy: 1984–2004. AIDS 19:2009–2018PubMedCrossRefGoogle Scholar
  27. 27.
    Mansergh G, Marks G, Colfax GN et al. (2002) Barebacking in a diverse sample of men who have sex with men. AIDS 16:653–659PubMedCrossRefGoogle Scholar
  28. 28.
    Van de Ven P, Kippax S, Crawford J et al. (2002) In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex. AIDS CARE 14:471–480PubMedCrossRefGoogle Scholar
  29. 29.
    Gold R, Skinner M (2001) Gay men’s estimates of the likelihood of HIV transmission in sexual behaviours. Int J STD AIDS 12:245–255PubMedCrossRefGoogle Scholar
  30. 30.
    Lane T, Pettifor A et al. (2006) Heterosexual anal intercourse increases risk of HIV infection among young South African men. AIDS 20:123–125PubMedCrossRefGoogle Scholar
  31. 31.
    Vittinghoff E, Douglas J et al. (1999) Per-contact risk of human immunodeficiency virus transmission between male sexual partners. Am J Epidemiol 150:306–312PubMedGoogle Scholar
  32. 32.
    Koblin BA, Husnik MJ et al. (2006) Risk factors for HIV infection among men who have sex with men. AIDS 20:731–739PubMedCrossRefGoogle Scholar
  33. 33.
    Auvert B, Taljaard D, Lagarde E et al. (2005) Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS Medicine; 2: e298. URL: http://www.plosmedicine.orgGoogle Scholar
  34. 34.
    Zuckerman RA, Whittington W et al. (2004) Higher concentration of HIV RNA in rectal mucosa secretions than in blood and seminal plasma, among men who have sex with men, independent of antiretroviral therapy. J Inf Dis 189:156–161CrossRefGoogle Scholar
  35. 35.
    Crawford JM, Kippax SC, Mao L et al. (2006) Number of risk acts by relationship status and partner serostatus: findings from the HIM cohort of homosexually active men in Sydney, Australia. AIDS Behav 10(3):325–331PubMedCrossRefGoogle Scholar
  36. 36.
    Prestage G, Mao L, Fogarty A et al. (2005) How has the sexual behaviour of gay men changed since the onset of AIDS: 1986–2003. Aust N Z J Public Health 29(6):530–535PubMedGoogle Scholar
  37. 37.
    Fenton KA, Lowndes CM et al. (2004) Recent trends in the epidemiology of sexually transmitted infections in the European Union. Sex Transm Infect 80:255–263PubMedCrossRefGoogle Scholar
  38. 38.
    RKI (2006) Gonorrhö und Chlamydien bei Männern, die Sex mit Männern haben. Epidemiol Bull (9):69–71Google Scholar
  39. 39.
    Bunnell R, Wamai N, Ekwaru JP et al. (2006) Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS 20:85–92PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Robert Koch-InstitutBerlinBRD
  2. 2.Robert Koch-InstitutBerlinBRD

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