New strategy against HIV - Your Life - prevention services for HIV-infected people should become a standard of care in all clinical settings

USA Today (Society for the Advancement of Education), March, 2004

In its latest attempt to reduce the number of new HIV infections nationwide, the Federal government is locating prevention programs squarely in the treatment setting. Selected by the Centers for Disease Control and Prevention and the Health Resources and Services Administration to address the challenge is the Center for Infectious Diseases at the University of North Carolina at Chapel Hill School of Medicine.

"Over the last decade or so, and despite extensive preventive efforts targeted at people not infected with HIV, 40,000 new ... cases are identified in the U.S. annually, a number that has remained somewhat consistent," points out Evelyn Byrd Quinlivan, assistant professor of medicine and director of the Infectious Diseases Clinic. "This number seems to represent a threshold beyond which no one has been able to move."

In 1999, the CDC requested that the Institute of Medicine, a component of the National Academy of Sciences, form the Committee on HIV Prevention Strategies in the United States. Among the committee members was Myron S. Cohen, professor of medicine, chief of infectious diseases, and director of the Center for Infectious Diseases. In 2001, Cohen and his colleagues published their recommendations in No Time to Lose: Getting More from HIV Prevention.

The book's underlying premise is that "each new infection begins with someone who is already infected." Thus, prevention can be enhanced by targeting the infected individual. "This is a total paradigm shift in thinking about prevention," Quinlivan says. "It recognizes that transmission occurs between two people, that current prevention efforts have addressed only hall of that interaction, and that we ought to think of new ways to resolve this problem."

Prevention services for HIV-infected people should become a standard of care in all clinical settings, such as primary care and mental health centers, sexually transmitted diseases clinics, and drug treatment facilities. Moreover, there is a need to develop effective "secondary prevention" programs that would integrate counseling and education activities into treatment of HIV-infected individuals.