HIV Prevention with Persons with HIV

On December 11, 2014, the Centers for Disease Control and Prevention released Recommendations for HIV Prevention with Adults and Adolescents with HIV in the United States, 2014, as described in thisDear Colleague Letter

This guideline:

Updates and expands the 2003 guideline, Incorporating HIV prevention into the medical care of persons living with HIV: recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America
Intends to advance the goals of the 2010 National HIV/AIDS Strategy for the United States: prevent new HIV infections, increase the proportion of persons with HIV who are aware of their infection, prevent HIV-related illness and death, and reduce HIV-related health disparities.
Compiles longstanding and new federal recommendations about biomedical, behavioral, and structural interventions that can help reduce the risk of HIV transmission from persons with HIV by reducing their infectiousness and their risk of exposing others to HIV. Presents a summary of recent scientific evidence, programmatic experience, and expert opinion that support the recommendations.
Is accompanied by three companion summaries, each of which lists the recommendations for one of the guideline’s three audiences:

Who developed this 2014 guideline?

The 2014 guideline was developed by the Centers for Disease Control and Prevention in collaboration with the following governmental and nongovernmental organizations:

Health Resources and Services Administration (HRSA)
National Institutes of Health
American Academy of HIV Medicine
Association of Nurses in AIDS Care
International Association of Providers of AIDS Care
National Minority AIDS Council
Urban Coalition for HIV/AIDS Prevention Services

A workgroup comprising more than 80 experts in HIV prevention and care from CDC and HRSA developed the guideline after examining the latest evidence-based federal guidance, scientific research, and program experience published through July 2014. The workgroup also considered expert opinions and input from more than 60 stakeholders from the collaborating organizations and American communities affected by HIV. These stakeholders included people with HIV, HIV medical care providers, nonclinical HIV prevention providers, staff of health departments and HIV planning groups, and experts in HIV policy and law.

Who should use this 2014 guideline?

The guideline is directed to three audiences:

Clinical providers who work in health care settings and who provide screening, diagnosis, treatment, and other health-related services. These providers include physicians, registered nurses, advance practice nurses, physician assistants, dentists, mental health providers, pharmacists, health educators, case managers, social workers, and counselors. Some may be employees or contractors of health departments.
Nonclinical providers who work in community-based organizations or health departments that operate outside of health care facilities and who provide HIV testing, health education, risk-reduction interventions, partner services, case management, or assistance with linkage or referral to medical and social services. These providers include HIV testing providers, peer and professional health educators, counselors, service linkage facilitators, partner services specialists, case managers, and social workers.
Staff of health departments and HIV planning groups who provide population-level HIV prevention and care services, such as HIV surveillance, community HIV education, or development of HIV-related policies.

The guideline may also interest persons with HIV; partners of persons with HIV; specialists in HIV planning, service delivery, policy, and legislation; and managers of medical assistance programs, health insurance plans, and health systems that serve persons with HIV.

How does the 2014 guideline differ from the 2003 guideline?

The 2014 guideline is directed to a broad audience of HIV prevention and care providers, whereas the 2003 guideline was directed only to health care providers working in clinical settings.
The new guideline updates and expands recommendations in the 2003 guideline related to:

Behavioral and biologic risk screening and behavioral risk-reduction interventions to reduce the risk of transmission
Sexually transmitted disease (STD) preventive services
Services for sex partners and drug-injection partners of persons with HIV
Referral for other medical and social services that influence HIV transmission or use of HIV services

The new guideline also addresses seven topics that were not described in detail in the 2003 guideline:

Individual, social, structural, ethical, legal, policy, and programmatic factors that influence HIV transmission and use of HIV prevention and care services
Linkage to and retention in HIV medical care
Use of antiretroviral treatment (ART) to improve health and to prevent HIV transmission
Methods to achieve sustained high adherence to ART to reduce infectiousness
Reproductive health care for women and men, including conception methods that reduce the risk of sexual HIV transmission and perinatal HIV transmission (if pregnancy occurs) and contraception methods to prevent unintended pregnancy
Pregnancy-related services to reduce the risk of sexual or perinatal transmission during recognized pregnancy
Methods to monitor, evaluate, and improve the quality of HIV prevention and care services and programs

What does the 2014 guideline include?

The guideline includes:

Summary and rationale for an expanded and updated guideline
Eleven sections that focus on various domains of HIV prevention (described above), each of which includes
- Complete list of recommendations for clinical providers, nonclinical providers, health departments, and HIV planning groups
- Summary of how the recommendations differ from past federal guidance on the topic
- Evidence supporting the recommendations
- Methods used to develop the recommendations
- List of implementation strategies and examples
A link to an online Resource Library of practical materials to help providers implement the recommendations
References, glossary, and a list of contributors

This guideline does not provide guidance on:

Comprehensive primary care for adults and adolescents with HIV
The prevention, diagnosis, and treatment of infections that are relatively common in persons with HIV but are not known to facilitate HIV transmission, such as viral hepatitis, some STDs, and most opportunistic infections
Prevention of HIV transmission from infants or young children

What resources can help providers implement the 2014 guideline?

Please visit the Resources page to access dozens of practical materials, such as decision-support tools, training resources, and fact sheets. The contents are regularly updated as new materials become available.