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A public health priority
Historically, HIV prevention initiatives have focused almost entirely on encouraging “harm reduction” behaviour in diverse at-risk HIV seronegative populations. Consequently, a growing number of behavioural interventions have been tested and applied to reduce HIV associated risk behaviours across diverse at-risk groups.1,2 In general, these programmes are theory driven and emphasise the development of cognitive, social, and technical competencies and skills associated with safer sex and drug use practices, and they attempt to modify individuals’ perceptions of peer norms as supporting HIV preventive practices.2 While designing effective risk reduction programmes for at-risk populations is a public health priority, one population that has been understudied and underserved with respect to sexual risk reduction prevention interventions is people living with HIV.
The HIV pandemic continues unabated. Globally, an estimated 36 million people are currently living with HIV.3 In the developing world, recent advances in HIV therapy have markedly decreased HIV associated mortality and HIV is now viewed as a chronic disease.4 However, unlike most other chronic diseases, HIV is also an infectious disease that can be transmitted to others. Thus, programmes specifically designed to address the needs of people living with HIV are essential for curtailing the HIV epidemic and should be a public health priority.5–9 Indeed, it should be axiomatic that prevention does not stop with HIV infection. Quite the contrary, prevention efforts should be intensified for those individuals living with HIV as, ultimately, only infected individuals can transmit HIV.5
There are several compelling clinical and public health reasons to design and implement sexual risk reduction prevention programmes for HIV positive individuals. Firstly, there is cogent empirical evidence suggesting that sexual risk behaviours, although often reduced by many HIV positive individuals, remain prevalent. As many as one in three HIV …