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Prevention With Positives: A Review of Published Research, 1998-2008

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HIV prevention education and counseling efforts have historically been directed toward those individuals considered at risk for exposure to HIV and assumed to be uninfected with HIV. In the late 1990s, prevention efforts began to include individuals who were HIV-infected. In 2003, the Centers for Disease Control and Prevention recommended that HIV prevention be incorporated into the medical care of persons living with HIV. This domain of HIV prevention work is known as prevention with positives or positive prevention, and research within this domain has been ongoing for a decade. This article provides a review of the scientific evidence within the prevention with positives domain from 1998 to 2008. A discussion is provided regarding early descriptive and formative studies as well as more recent and ongoing intervention trials specifically designed for persons living with HIV. A summary of current knowledge, a description of ongoing research, and gaps in knowledge are identified. Topics for future research are suggested.

Section snippets

Progression of the Research Agenda

Research in the domain of HIV prevention for positives is progressing slowly, as one might expect in a newly identified domain of study. Early research was dominated by descriptive studies that examined characteristics of patients, providers, clinics, and clinic visits. These early formative studies provided the foundation for the next phase of intervention research. Intervention trials may be viewed through a variety of lenses, such as the theoretical foundation used (see Table 1), design of

Preliminary Studies

This discussion of preliminary studies focuses on those descriptive and formative studies that described current prevention efforts for PLWH during the period between 1995 and 2002. These studies were designed to examine characteristics of patients, providers, clinics, and clinic visits that informed the development of the later intervention trials. A study by Gerbert et al. (1999) was considered to be the first qualitative study to explore the domain of what eventually became known as

Discussion

A total of 17 trials were discussed in this review, and 11 have reported preliminary outcome data. There is abundant evidence that interventions delivered to either groups or individuals in a variety of formats can effectively reduce HIV transmission risk behaviors. Assessments of relative efficacy to determine superiority of methods are not yet available. However, it is clear that a brief intervention delivered within the context of a routine medical visit by any member of the health care team

Conclusions

As the first decade of research on prevention with positives draws to a close, these encouraging preliminary results can provide guidance to immediately inform clinical practice. As more reports from specific intervention trials become available, evidence-based knowledge in the domain of prevention with positives will expand, and interventions will be incorporated into standards of care. Additionally, in this era of cost-containment, providers will be encouraged toward 100% participation in

Patricia P. Gilliam, ARNP, PhD(c), is a doctoral candidate, University of South Florida College of Nursing, and adult nurse practitioner, St. Joseph's Hospital Tampa Care Clinic, Tampa, Florida.

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    • Patricia P. Gilliam, ARNP, PhD(c), is a doctoral candidate, University of South Florida College of Nursing, and adult nurse practitioner, St. Joseph's Hospital Tampa Care Clinic, Tampa, Florida.

    Diane M. Straub, MD, MPH, is associate professor of pediatrics and chief, Division of Adolescent Medicine, University of South Florida, Tampa.

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