Positive Prevention: HIV Risk Reduction for People Living with HIV/AIDS

  • Seth C. Kalichman
  • Leickness C. Simbayi


Over the history of the HIV/AIDS pandemic there have been remarkable successes in stemming the spread of HIV, including reductions in unsafe sex in United States and European gay communities in the early 1980s and averting an AIDS catastrophe in Uganda in the 1990s. Effective HIV screening programmes have yielded universally safe blood supplies, antiretroviral (ARV) therapies have the potential to all but eliminate perinatal HIV transmission and male circumcision has been proven to reduce the risk of female-to-male HIV sexual transmission. Along with these successes have also come several prevention disappointments. The search for new approaches to preventing HIV transmission has included cervical protective barriers, suppression of herpes simplex virus, vaginal microbicides and most notably a safe and effective prophylactic HIV-1 vaccine, none of which has yet demonstrated efficacy. In light of the discouraging progress in biomedical approaches to HIV prevention as well as the continued amplification of the HIV/AIDS pandemic, there is renewed interest in behavioural strategies for preventing new HIV infections.


Male Circumcision Viral Burden Human Science Research Council Positive Prevention Safe Blood Supply 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Preparation of this chapter was supported by grants R01-MH71164 and R01-MH74371 from the US National Institute of Mental Health (NIMH)


  1. Auvert, B., Males, S., Puren, A., Taljaard, D., Carael, M., and Williams, B. (2004). Can highly active antiretroviral therapy reduce the spread of HIV? A study in a township in South Africa. Journal of Acquired Immune Deficiency Syndromes, 36, 613–621.PubMedCrossRefGoogle Scholar
  2. Bernard, H. (2008). Treatment as prevention: the effect of HAART on infectiousness. International AIDS Conference, Mexico City.Google Scholar
  3. Bunnell, R., Ekwaru, J., Solberg, P., Wamai, N., Bikaako-Kajura, W., Were, W., Coutinho, A., Liechty, C., Madraa, E., Rutherford, G., and Mermin, J. (2006a). Changes in sexual behaviour and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS, 20, 85–92.PubMedCrossRefGoogle Scholar
  4. Bunnell, R., Mermin, J., and DeCock, K. (2006b). HIV prevention for a threatened continent: implementing positive prevention in Africa. JAMA, 296, 855–858.PubMedCrossRefGoogle Scholar
  5. Centers for Disease Control and Prevention. (2003). Advancing HIV prevention: new strategies for a changing epidemic – United States. MMWR, 52(15), 329–332.Google Scholar
  6. Cohen, M., Hoffman, I., Royce, R., et al. (1997). Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. Lancet, 349, 1868–1873.PubMedCrossRefGoogle Scholar
  7. Crepaz, N., Lyles, C., Wolitski, R., et al. (2006). Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS, 20, 143–157.PubMedCrossRefGoogle Scholar
  8. Diamond, C., Richardson, J., Milan, J., Stoyanoff, S., McCutchan, J., Kemper, C. et al. (2005). Use of and adherence to antiretroviral therapy is associated with decreased sexual risk behaviour in HIV clinic patients. Journal of Acquired Immune Deficiency Syndromes, 39, 211–218.PubMedGoogle Scholar
  9. Dyer, J.R., Vernazza, P.L., Gilliam, B.L., Maida, M., Zimba, D., Hoffman, I.F., Royce, R.A., Schock, J.L., Fiscus, S.A., Cohen, M.S., and Eron, J.J. (1998). High levels of human immunodeficiency virus type in blood and semen of seropositive men in sub-Saharan Africa. Journal of Infectious Diseases, 177, 1742–1746.PubMedCrossRefGoogle Scholar
  10. Eisele, T., Mathews, C., Chopra, M., Lurie, M., Brown, L., Dewing, S., and Kendall, C. (2008). Changes in risk behaviour among HIV-positive patients during their first year of antiretroviral therapy in Cape Town South Africa. Epub ahead of print, AIDS and Behaviour.Google Scholar
  11. Fisher, J., Fisher, W., Cornman, D., Amico, R., Bryan, A., and Friedman, G. (2006). Clinician-delivered intervention during routine clinical care reduces unprotected sexual behaviour among HIV-infected patients. Journal of Acquired Immune Deficiency Syndromes, 41, 44–52.PubMedCrossRefGoogle Scholar
  12. Fisher, J., Cornman, D.H., Kiene, S.M., Christie, S., Fisher, W.A., Shuper, P.A., Pillay, S., Friedland, D.H., Thomas, C.M., Lodge, L., and Fisher, J.D. (2008). Clinic-based intervention reduces unprotected sexual behaviour among HIV-infected patients in Kwazulu-Natal, South Africa: Results of a pilot study. Journal of Acquired Immune Deficiency Syndromes, 48, 553–560.PubMedCrossRefGoogle Scholar
  13. Galletly, C., and Pinkerton, S. (2008). Conflicting messages: how criminal HIV disclosure laws undermine public health efforts to control the spread of HIV. AIDS and Behaviour. doi: 10.1023/A:1014572427706.Google Scholar
  14. International Council of AID Service Organizations (2008). International AIDS Conference, Mexico City Conference news,
  15. Johnson, B.T., Carey, M.P., Chaudoir, S.R., and Reid, A.E. (2006). Sexual risk reduction for persons living with HIV: research synthesis of randomized controlled trials, 1993 to 2004. Journal of Acquired Immune Deficiency Syndromes, 41, 642–650.PubMedCrossRefGoogle Scholar
  16. Kalichman, S.C. (2005). Positive prevention: A sourcebook for HIV transmission risk reduction among people living with HIV/AIDS. New York: Springer Science.Google Scholar
  17. Kalichman, S.C., DiBerto, G., and Eaton, L.E. (2008). Associations among HIV concentration in blood plasma and semen: Review and implications of empirical findings. Sexually Transmitted Diseases, 35, 55–60.PubMedCrossRefGoogle Scholar
  18. Kalichman, S.C., Rompa, D., Cage, M., DiFonzo, K., et al. (2001).Effectiveness of an intervention to reduce HIV transmission risks in HIV positive persons. American Journal of Preventive Medicine 21, 84–92.PubMedCrossRefGoogle Scholar
  19. Kozal, M.J., Amico, K.R., Chiarella, J., Schreibman, T., Cornman, D., Fisher, W., Fisher, J., and Friedland, G. (2004). Antiretroviral resistance and high-risk transmission behaviour among HIV-positive patients in clinical care. AIDS, 18, 2185–2189.PubMedCrossRefGoogle Scholar
  20. Levy, N., Miksad, R., and Fein, O. (2005). From treatment to prevention: the interplay between HIV/AIDS treatment availability and HIV/AIDS prevention programming in Khayelitsha, South Africa. Journal of Urban Health, 82, 498–509.PubMedCrossRefGoogle Scholar
  21. Lurie, M., Pronyk, P., de Moor, E., Heyer, A., de Bruyn, G., Struthers, H., McIntyre, J., Gray, G., Marinda, E., Klipstein-Grobusch, K., and Mertinson, N. (2008). Sexual behaviour and reproductive health among HIV infected patients in urban and rural South Africa. Journal of Acquired Immune Deficiency Syndromes, 47, 484–493.PubMedCrossRefGoogle Scholar
  22. Park, C. (2008) Positive prevention a human rights perspective. International AIDS Conference, Mexico City.Google Scholar
  23. Pilcher, C.D., Tien, H.C., Eron, J.J., Vernazza, P.L., Leu, S.Y., Stewart, P.W., Goh, L.E., and Cohen, M.S. (2004). Brief but efficient: acute HIV infection and the sexual transmission of HIV. Journal of Infectious Diseases, 189, 1785–1792.PubMedCrossRefGoogle Scholar
  24. Quinn, T.C., Wawer, M.J., Sewankambo, N., Serwadda, D., Li, C., Wabwire-Mangen, F., Meehan, M.O., Lutalo, T., and Gray, R.H. (2000). Viral load and heterosexual immunodeficiency virus type 1. Rakai Project Study Group. New England Journal of Medicine, 30, 970–972.Google Scholar
  25. Richardson, J.L., Milam, J., McCutchan, A., Stoyanoff, S., Bolan, R., Weiss, J., Kemper, C., Larsen, R.A., Hollander, H., Weismuller, P., Chou, C.P., and Marks, G. (2004). Effect of brief safer-sex counselling by medical providers to HIV-1 seropositive patients: A multi-clinic assessment. AIDS, 18, 1179–1186PubMedCrossRefGoogle Scholar
  26. Ross, L., Lim, M.L., Liao, Q., Wine, B., Rodriguez, A.E., Weinberg, W., and Shaefer, M. (2007). Prevalence of antiretroviral drug resistance and resistance-associated mutations in antiretroviral therapy-naive HIV-infected individuals from 40 United States cities. HIV Clinical Trials, 8, 1–8.PubMedCrossRefGoogle Scholar
  27. Rotheram-Borus, M.J., Lee, M.B., Murphy, D.A., Futterman, D., Duan, N., Birnbaum, J., Teens Linked to Care Consortium. (2001). Efficacy of a preventive intervention for youth living with HIV. American Journal of Public Health, 91, 400–405.PubMedCrossRefGoogle Scholar
  28. Shisana, O., Rehle, T., Simbayi, L., Parker, W., Bhana, A., Zuma, K., Connoly, C., Jooste, S., and Pillay, V. (2005). South African national HIV prevalence, incidence, behaviour and communication survey. Cape Town: Human Sciences Research Council Press.Google Scholar
  29. Simbayi, L.C., Kalichman, S.C., Strebel, A., Cloete, A., Henda, N., and Mqeketo, A. (2007). Disclosure of HIV status to sex partners and sexual risk behaviours among HIV positive men and women, Cape Town, South Africa. Sexually Transmitted Infections, 83, 29–34.PubMedCrossRefGoogle Scholar
  30. Smit, J., Myer, L., Middelkoop, K., Seedat, S., Wood, R., Bekker, L., and Stein, D. (2006). Mental health and sexual risk behaviours in a South African township: a community-based cross-sectional study. Public Health, 120, 534–542.PubMedCrossRefGoogle Scholar
  31. South African Department of Health. (2007). HIV & AIDS and STI National Strategic Plan 20072011. South African National AIDS Council (SANAC): Pretoria, South Africa.Google Scholar
  32. Trossero, A. (2008). Sexual and reproductive health and rights: repercussions on positive prevention. International AIDS Conference, Mexico City.Google Scholar
  33. UNAIDS. (2008). Antiretroviral therapy and sexual transmission of HIV. Available at
  34. Voluntary HIV-1 Counselling and Testing Efficacy Study Group. (2000). Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomized trial. Lancet, 356, 103–112.CrossRefGoogle Scholar
  35. Weinhardt, L.S., Carey, M.P., Johnson, B.T., and Bickham, N.L. (1999). Effects of HIV counselling and testing on sexual risk behaviour: a meta-analytic review of published research, 1985–1997. American Journal of Public Health, 89, 1397–405.PubMedCrossRefGoogle Scholar
  36. Weiser, S.D., Leiter, K., Bangsberg, D.R., Butler, L.M., Percy-de Korte, F., et al. (2007). Food insufficiency is associated with high risk sexual behaviour among women in Botswana and Swaziland. PLoS Med, 4(10), 1589–1598.PubMedCrossRefGoogle Scholar
  37. Wilson, T., Barron, Y., Cohen, M., Richardson, J., Greenblatt, R., Sacks, H., and Young, M. (2002). Adherence to antiretroviral therapy and its association with sexual behaviour in a national sample of women with human immunodeficiency virus. AIDS, 34, 529–534.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Seth C. Kalichman
    • 1
  • Leickness C. Simbayi
    • 2
  1. 1.Center for HIV Intervention and PreventionUniversity of South CarolinaStorrsUSA
  2. 2.Human Sciences Research CouncilCape TownSouth Africa

Personalised recommendations