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R O Valdiserri
CDC, Atlanta, GA
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Background: HIV incidence rates in the U.S. were estimated to be stable throughout the 1990s, at approximately 40,000 new infections per year–down from an estimated high of 150,000 annual infections in the mid 1980s. However, recent trends in HIV diagnoses, sexual behavior among HIV+ persons, and national syphilis rates lead to concerns about a possible upturn in HIV incidence in the U.S.
Methods: This plenary will synthesize information from a variety of sources including published and unpublished national surveillance data, epidemiologic studies, published randomized controlled trials of behavioral risk-reduction interventions, and meta-analyses of interventions aimed at reducing the risk of HIV transmission.
Results: A variety of individual studies and meta-analyses demonstrate substantial effect sizes for behavioral risk reduction interventions targeting both sexual and drug-using risk behaviors. In addition to positive behavioral outcomes, several interventions have demonstrated decreases in incident sexually transmitted diseases following HIV prevention behavioral interventions. However, despite these positive findings, there have been recent syphilis outbreaks involving men-who-have-sex-with-men (MSM) in cities such as Miami, New York City, and Los Angeles. Investigations of these outbreaks revealed that 43%–59% of the men with syphilis were known HIV positives, with many already under care for their HIV disease. Possible reasons for resurgent high-risk behavior among these men include HIV/AIDS complacency, prevention "burn-out," and mistaken beliefs about infectiousness vis-a-vis viral load levels.
Conclusion: It is estimated that between 850,000 and 950,000 persons in America are living with HIV or AIDS. Given the growing number of persons living with HIV in the U.S., medical care providers have an important, ongoing role to play in reinforcing prevention messages and offering diagnosis and treatment for other STDs to "high risk" patients, e.g., those who are not involved in stable monogamous relationships. Recent work has shown that it is possible to improve HIV/STD risk assessment and counseling rates in a "real world" setting with a relatively non-intensive intervention. Given the increasing importance of prevention for HIV seropositives, care providers can make a substantial contribution to reducing new infections and achieving national prevention goals.
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