Rose Carol Dawson, Koester Kimberly A, Kang Dufour Mi-Suk, Myers Janet J, Shade Starley B, McCready Karen, Morin Stephen
Center for AIDS Prevention Studies, University of California, San Francisco, 94105, USA.
AIDS Care. 2012;24(6):704-11. doi: 10.1080/09540121.2011.644232. Epub 2012 Feb 2.
Prevention with Positives (PwP) is a component of the US HIV prevention strategy that targets HIV-infected persons who are aware of their seropositive status. This paper examines the use of prevention messages by clinical providers during the PwP intervention period of the US Health Resources and Services Administration's Special Projects of National Significance program. Quantitative approaches were used to learn which prevention topics were most discussed and qualitative interviews were also utilized to better understand the clinician perspective in providing prevention counseling. At 12-month follow-up, there was a significant increase in the percent of patients receiving all PwP counseling messages (p<0.01). Providers reported discussing safer sex with 91% of patients when sexually transmitted infection (STI) screening was conducted during a visit, an increase from baseline (83.5%). The percent of providers reporting they regularly explained the risk of superinfection to their clients also increased from 75% at baseline to 90% at 12-month follow up (p<0.001). Qualitative data suggest that providers prioritize individual care over public health approaches to PwP in counseling. Discussing superinfection offered providers a way to discuss HIV prevention from a non-judgmental clinical perspective while focusing on a patient-centered philosophy of care. However, the threat of superinfection may not be the best counseling option. Examples such as STI screening, giving messages to reduce the number of sexual partners and adherence to medication, are more evidence-based approaches to changing HIV transmission risk behavior and may be more important in PwP. Findings suggest that in order for HIV care providers to incorporate HIV prevention discussions into their practice, acceptable approaches to speaking about risk behavior and prevention of HIV transmission must be developed.
“阳性预防”（Prevention with Positives，PwP）是美国艾滋病预防策略的一个组成部分，目标是针对知晓自身血清学阳性状态的艾滋病病毒感染者。本文考察了美国卫生资源与服务管理局具有全国意义的特殊项目中，临床医护人员在“阳性预防”干预期间对预防信息的使用情况。采用定量方法了解讨论最多的预防主题，同时运用定性访谈以更好地理解临床医生在提供预防咨询方面的观点。在12个月的随访中，接受所有“阳性预防”咨询信息的患者比例显著增加（p<0.01）。医护人员报告称，在就诊时进行性传播感染（STI）筛查时，91%的患者会讨论安全性行为，较基线水平（83.5%）有所增加。报告定期向患者解释重复感染风险的医护人员比例也从基线时的75%增至12个月随访时的90%（p<0.001）。定性数据表明，在咨询中，医护人员优先考虑个体护理而非公共卫生方法来进行“阳性预防”。讨论重复感染为医护人员提供了一种从无偏见的临床角度讨论艾滋病预防的方式，同时专注于以患者为中心的护理理念。然而，重复感染的威胁可能并非最佳的咨询选项。例如性传播感染筛查、传达减少性伴侣数量以及坚持服药等信息，是改变艾滋病病毒传播风险行为的更具循证性的方法，在“阳性预防”中可能更为重要。研究结果表明，为使艾滋病护理人员将艾滋病预防讨论纳入其实践，必须制定关于谈论风险行为和预防艾滋病病毒传播的可接受方法。
