The CDC, along with the Health Resources and Services Administration, NIH and the HIV Medicine Association of the Infectious Diseases Society of America, yesterday released in the MMWR Recommendations and Reports guidelines for doctors and other health care providers that discuss how they can incorporate HIV prevention messages into the routine medical care of their HIV-positive patients, the Atlanta Journal-Constitution reports. The guidelines suggest that providers take three steps: screen for high-risk behaviors using questionnaires and tests for other STDs; discuss proper condom and needle use; and encourage notification and counseling for sex and drug partners (Wahlberg, Atlanta Journal-Constitution, 7/18). The recommendations are "general and apply to incorporating HIV prevention into the medical care of all" HIV-positive adolescents and adults -- "regardless of age, sex, or race/ethnicity," the guidelines state. In addition, the guidelines focus on high-risk sexual and injection drug use behaviors because "these behaviors are responsible for nearly all HIV transmission in the United States," according to the guidelines (Jaffe/Janssen, MMWR Recommendations and Reports, 7/18). CDC Director Julie Gerberding said, "It's time we merge prevention services for HIV-infected persons into the mainstream of medical care" (Reuters, 7/17). Dr. Robert Janssen, head of the CDC's Division of HIV/AIDS Prevention, said, "We focused in the past on people at risk of becoming infected. Now we're trying to bring up to speed interventions for people who are infected and can transmit the virus to others" (Atlanta Journal-Constitution, 7/18).

Too Much Burden?
Dr. John Bartlett, chief of infectious diseases at Johns Hopkins University School of Medicine and a member of the panel that developed the guidelines, said that the new recommendations place "a lot of the burden of the prevention message on the provider." Dr. Ronald Valdiserri, deputy director of the CDC's National Center for HIV, STD and TB Prevention, said, "It's not the easiest thing for many physicians to be able to talk about sex and drug use with their clients," but he added that some studies indicate that doctors who go through only one day of training significantly improve their ability to talk about these issue with their patients, according to the AP/Las Vegas Sun (Yee, AP/Las Vegas Sun, 7/17). Some HIV/AIDS advocates lauded the new guidelines but expressed concern that doctors who are "already stressed for time and burdened by paperwork" would not be able to implement the guidelines' suggestions, the Journal-Constitution reports. Jeff Graham, executive director of the AIDS Survival Project in Atlanta, said, "This is an area that has been overlooked for far too long, but I am concerned that most of these recommendations will be ignored" (Atlanta Journal-Constitution, 7/18).

Part of New Prevention Strategy
The recommendations come after Gerberding in April called for new HIV/AIDS prevention strategies (AP/Las Vegas Sun, 7/17). The agency in the April 18 issue of the Morbidity and Mortality Weekly Report outlined new prevention guidelines, which include provisions for an opt-out testing program for pregnant women in an effort to reduce mother-to-child HIV transmission. The strategy calls for all pregnant women to be tested for HIV, along with a battery of other routine tests already conducted on pregnant women, including tests for syphilis, rubella, group B Strep and hepatitis. The guidelines also include: offering routine HIV tests as a part of medical appointments for patients at high risk; offering rapid HIV tests in non-medical settings, including jails and homeless shelters; and tracing partners of those who test positive for HIV in order to offer them testing and prevention education (Kaiser Daily HIV/AIDS Report, 4/18).

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