HIV Prevention (eBook)

Front cover 1
HIV prevention: A comprehensive approach 4
Copyright page 5
Contents 8
Foreword 12
About the editors 18
Notes on contributors 20
Acknowledgments 40
Introduction 42
Part I: Epidemiological and biological issues in HIV prevention 50
Chapter 1 Current and future trends: implications for HIV prevention 52
Estimates and projections: methodology and refinements 54
Sub-pandemics in different world regions 55
Conceptual framework for HIV prevention 58
Multimodality of risk factors and impact on prevention interventions 61
Future trends 64
Conclusions 65
References 65
Chapter 2 Understanding the biology of HIV-1 transmission: the foundation for prevention 72
The assault force: HIV in genital secretions 73
Establishing a beachhead: the cellular organization of genital tract and rectal tissues, and early events in HIV sexual transmission 78
Summary and future directions 85
References 86
Chapter 3 HIV vaccines 94
Transmission and immunology of HIV and associated vaccine challenges 95
Challenges for HIV vaccine development 97
Vaccine approaches and evaluations 100
Vaccine candidates 102
Vaccine trials 109
The future of HIV vaccine efforts 120
Conclusions 121
Acknowledgment 121
References 122
Chapter 4 Microbicides 126
The biological rationale for microbicides 127
Microbicide development 129
The microbicide pipeline 132
Challenges to microbicide development 134
Socio-cultural perspectives on trial conduct in the developing world 137
Microbicides as part of the broader prevention agenda 141
Providing access to microbicides 143
Microbicide development remains a critical component of HIV prevention research 144
References 144
Chapter 5 Using antiretrovirals to prevent HIV transmission 148
HIV transmission 148
HIV in genital secretions 149
ART pharmacology 150
ART to Prevent Transmission of HIV 153
ART for post-exposure prophylaxis (PEP) 156
Clinical studies of non-occupational post-exposure prophylaxis 159
Pre-exposure prophylaxis to prevent HIV transmission 164
ART as public health prevention 167
ART and sexual behaviors: non-occupational post-exposure prophylaxis 169
ART resistance 172
Possible future strategies for ART as prevention: acute HIV infection 172
Conclusions 174
Acknowledgments 175
References 175
Chapter 6 Male circumcision and HIV prevention 187
Observational data on male circumcision and heterosexual HIV acquisition in men 187
Male circumcision and HIV acquisition in men who have sex with men 189
Randomized trials of male circumcision for HIV prevention in men 190
Biological evidence for the protective effects of circumcision for HIV prevention in men 193
Circumcision and STI acquisition in men 195
Male circumcision and HIV/STI infections in women 197
The safety of male circumcision 198
The prevalence and acceptability of male circumcision 199
Male circumcision and behavioral disinhibition or risk compensation 200
Modeling of the effects of male circumcision on population HIV incidence, the number of surgeries and cost per HIV infection averted 200
Scale-up of circumcision programs 201
References 203
Part II: Behavioral issues in HIV prevention 208
Chapter 7 Payoff from AIDS behavioral prevention research 210
Periods in AIDS prevention research 212
Conclusions 236
Acknowledgments 237
References 237
Chapter 8 Individual interventions 244
Stage 1: Common theoretical models applicable to individual interventions for HIV prevention 246
Stage 2: Selected efficacy trials of HIV prevention interventions based on the conceptual models 254
Stage 3: Summary and conclusions 273
Acknowledgment 276
References 276
Chapter 9 Couples' voluntary counseling and testing 281
Prevention through behavior change remains the best tool to control the epidemic 281
CVCT and correct and consistent condom use: what is known to work at the dyad level 282
Towards sustainable HIV prevention: structural and economic aspects, psychosocial elements, and social norms 285
Controversies: past and present 290
Best practices: a day in the life of a same-day CVCT clinic 292
Monitoring and evaluation of CVCT services 296
Twenty years of barriers and progress/concrete gains as CVCT evolves 298
Conclusion 300
References 301
Chapter 10 Updating HIV prevention with gay men: current challenges and opportunities to advance health among gay men 308
What is the evidence base for efficacy of HIV prevention efforts among gay men? 310
What are the current challenges in HIV prevention work among gay men? 311
Community viral load approaches to HIV prevention: reducing risk by changing context 315
How can we translate efficacy into effectiveness? 316
Towards a prevention cocktail: strategies to move HIV prevention among gay men forward 317
Steps toward the creation of a prevention cocktail 319
References 320
Chapter 11 Reducing sexual risk behavior among men and women with HIV infection 322
Sexual behavior among PLWHA 323
Intervention research addressing reduction in HIV transmission risk among PLWHA 329
Integration of HIV prevention programs into the clinical setting 336
Conclusions 339
References 340
Chapter 12 Injection drug use and HIV: past and future considerations for HIV prevention and interventions 346
Political and social context of injection drug use 346
Epidemiology of HIV infection among IDUs 348
Factors that have informed prevention and intervention strategies 353
Successful and unsuccessful interventions 362
Future directions 371
Acknowledgment 372
References 372
Chapter 13 HIV risk and prevention for non-injection substance users 381
Types of interventions used to treat substance use problems 383
Alcohol 385
Non-alcohol substance use 389
Use of other substances and HIV risk 398
Conclusions 401
References 401
Chapter 14 Preventing HIV among sex workers 417
Epidemiology, HIV risk and vulnerability among sex workers 418
Elements of effective interventions 426
The intervention gap and the need to scale up sex-worker interventions 434
Model programs from around the world 436
Challenges for setting up HIV prevention programs for sex workers 439
References 440
Chapter 15 Interventions with youth in high-prevalence areas 448
Epidemiology of HIV infection in youth 450
Young women and sexual risk 451
Reducing HIV risk 457
HIV prevention interventions in youth 461
Lessons learned from interventions targeted at youth 475
Conclusion 476
References 477
Chapter 16 Interventions with incarcerated persons 485
Epidemiology: the epidemic of incarceration in the United States 485
Prevention interventions 490
HIV/AIDS in international prisons 503
Future directions 505
Acknowledgments 506
References 506
Chapter 17 Preventing mother-to-child transmission of HIV 513
Progress in preventing mother-to-child transmission of HIV 514
Factors affecting mother-to-child transmission 514
Principles of prevention of MTCT: a comprehensive approach 515
Preventing mother-to-child transmission in high-resource settings: PMTCT advances 517
Preventing MTCT in low-resource settings: advances 519
Infant feeding: mother-to-child transmission through breastfeeding 524
From research to implementation 529
References 529
Part III: Structural and technical issues in HIV prevention 540
Chapter 18 Harm reduction, human rights and public health 542
Review of harm reduction interventions among vulnerable populations 545
The HIV epidemic among sex workers 548
The HIV epidemic among MSM 550
The HIV epidemic among incarcerated populations 552
Interplay between harm reduction, human rights and public health 554
Discussion 557
References 558
Chapter 19 HIV testing and counseling 565
History of HIV testing and counseling 565
HIV testing and counseling and behavior change 568
HIV testing and counseling models 572
Expanding HIV testing and counseling to reach specific populations 576
Continuing challenges and emerging issues 581
Advancing HIV testing and counseling 584
References 585
Chapter 20 Structural interventions in societal contexts 591
Venue-based approaches: wine shops to red-light districts 591
Social-network based approaches: prevention targeted at negotiating safe sex 593
Daughters, wives, and mothers: the impact of subordinating women in the home and community 595
Socially-driven public health responses 600
Targeting the individual in HIV prevention: condoms and antiretrovirals 604
Socially relevant HIV prevention 607
References 608
Chapter 21 Evaluating HIV/AIDS programs in the US and developing countries 612
Issues in defining the evaluation design 612
Types of summative evaluation 615
Major challenges in evaluating HIV/AIDS programs 627
Conclusion 630
References 630
Chapter 22 Adapting successful research studies in the public health arena: going from efficacy trials to effective public health interventions 632
Evaluating efficacy, effectiveness, and impact of biological interventions on HIV and STI incidence 633
Evaluating efficacy, effectiveness, and impact of behavioral interventions on HIV and STI risk behavior 636
Promoting the successful implementation of science-based HIV prevention: the CDC's approach 637
Emerging issues and challenges 646
Conclusions 651
Acknowledgment 653
Disclaimer 653
References 653
Index 660
A 660
B 662
C 664
D 668
E 668
F 670
G 670
H 671
I 673
J 675
K 675
L 676
M 676
N 678
O 680
P 680
R 682
S 683
T 687
U 688
V 689
W 691
Y 691
Z 692