Prevention programmes for HIV-positive people

People with HIV form 50% of those present at any HIV-transmission event and yet are a minority of the population. So, it might be argued, programmes targeted at them may have a disproportionate effect.

One 1999 paper1 comments:

“Preventive interventions with positive individuals are likely to have a greater impact on the epidemic, for an equivalent input of cost, time, resources, than preventative interventions focused on negative individuals. A change in the risky behaviour of an HIV positive person will, on average, and in almost all affected populations, have a much bigger impact on the spread of the virus than an equivalent change in the behaviour of an HIV negative person.”

Yet, throughout the history of the epidemic, far fewer prevention resources have been directed at people living with HIV than at the uninfected. In the draft version of its guide on ‘Positive Prevention’,2 the International HIV/AIDS Alliance suggested why:

“Most prevention strategies to date have been targeted at uninfected people to prevent them from becoming infected with HIV. Historically, there has been a reluctance to work on HIV/STI prevention with people with HIV because of perceptions that the concept of prevention for people already infected is inherently contradictory.

“There have also been justifiable concerns about victimising an already stigmatised group. In addition, there has been a reluctance to acknowledge that people with HIV have sex, and also to get to grips with the complex ethical issues surrounding people with HIV’s responsibilities towards others.”

In the final version, it went further:

“It has been common in some settings for counsellors and nurses to tell HIV positive people that they should abstain from sex completely or just have sex with someone else who is HIV positive. This advice may not be helpful to their psychological health on the one hand and on the other hand may expose them to re-infection. It also does not help the majority of HIV positive people who continue to be sexually active, nor those who are in relationships with HIV negative partners and want to continue a safer sexual relationship. The role of health service providers is to ensure that HIV positive people gain the skills they need to negotiate safer sex and maintain healthy sexual relationships.”

‘Positive prevention’ is therefore potentially an effective tool against HIV, but not always one that has a positive effect on people with HIV.

The International HIV/AIDS Alliance proposes a very wide definition of what ‘positive prevention’ is, dividing the activity into 17 different strategies.  This is shown in the graphic below, taken from the 2003 draft.

Individually focused health promotion

Scaling up, targeting and improving service and commodity delivery

Community mobilisation

Advocacy, policy change and community awareness

Strategy 1: Promoting voluntary counselling and testing

Strategy 5: Ensuring availability of voluntary counselling and testing

Strategy 9: Facilitating post-test clubs and other peer support groups

Strategy 14: Involving people with HIV in decision-making for Positive Prevention

Strategy 2: Providing post-test and ongoing counselling for positive people

Strategy 6: Providing antiretroviral treatment for Positive Prevention

Strategy 10: Implementing focused communication campaigns

Strategy 15: Advocacy for Positive Prevention

Strategy 3: Encouraging beneficial disclosure and ethical partner notification

Strategy 7: Reducing stigma and integrating Positive Prevention into treatment centres

Strategy 11: Training people with HIV as peer outreach workers

Strategy 16: Legal reviews and legislative reform

Strategy 4: Providing counselling for serodiscordant couples

Strategy 8: Providing services for preventing mother-to-child transmission

Strategy 12: Reinforcing Positive Prevention through home-based care

Strategy 17: Advocacy for access to treatment



Strategy 13: Addressing HIV-related gender-based violence in Positive Prevention


International HIV/AIDS Alliance ( Draft background paper July 2003.

This grid of 17 strategies does not in any way make any recommendations as to the content or methodology of any of the strategies it recommends. How is voluntary counselling and testing to be promoted and how voluntary is voluntary? How does one encourage beneficial disclosure and reduce stigma? How can peer support promote safer sex practices? What content should focused communication campaigns have? And, if you involve people with HIV in positive prevention, what will they say they want?


  1. King-Spooner S HIV prevention and the positive population. Int J STD AIDS 10(3):141-50, 1999
  2. International HIV/AIDS Alliance Positive Prevention: HIV Prevention for People with HIV. Brighton, 2007
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.