Abstract

The estimated number of annual new human immunodeficiency virus (HIV) infections in the United States has remained at 40,000 for >10 years. Reducing the rate of transmission will require new strategies, including emphasis on prevention of transmission by HIV-infected persons. Medical care providers can affect HIV transmission by screening HIV-infected patients for risk behaviors, communicating prevention messages, discussing sexual and drug-use behaviors, reinforcing changes to safer behavior, referring patients for services such as substance abuse treatment, facilitating partner counseling and referral, and identifying and treating other sexually transmitted diseases. The Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), and the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA) have recently collaborated to develop evidence-based recommendations for incorporating HIV prevention into the medical care of persons living with HIV. This article summarizes key aspects of the recommendations.

The estimated number of annual new HIV infections in the United States has remained at 40,000 for over 10 years [1]. Reducing the rate of HIV transmission will require new strategies, including increased emphasis on preventing transmission by persons living with HIV [2, 3]. Clinicians providing medical care to HIV-infected persons can play a key role in helping their patients reduce risk behaviors and maintain safer sexual and drug-using practices and can do so with a feasible level of effort, even in constrained practice settings. The Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), and the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA) have recently collaborated to develop recommendations for incorporating HIV prevention into the medical care of persons living with HIV [4]. The recommendations were developed using an evidence-based approach (table 1). The strength of each recommendation is indicated on a scale of A (strongest recommendation for) to E (recommendation against); the quality of available evidence supporting the recommendation is indicated on a scale of I (strongest evidence for) to III (weakest evidence for), and the outcome for which the recommendation is rated is provided. The recommendations are categorized into 3 major components: (1) screening for HIV transmission risk behaviors and sexually transmitted diseases (STDs); (2) providing, and referring for, behavioral risk-reduction interventions and related services; and (3) facilitating notification, counseling, and testing of infected persons' partners. This article summarizes key aspects of the recommendations for readers of this journal.

Table 1

Rating systems for strength of recommendations and quality of evidence supporting the recommendations.

Table 1

Rating systems for strength of recommendations and quality of evidence supporting the recommendations.

Risk Screening

Risk screening, a brief assessment of behavioral and clinical factors associated with transmission of HIV and other STDs, can be used to identify patients who should receive more in-depth risk assessment, HIV risk-reduction counseling, other risk-reduction interventions, or referral for other services (e.g., substance abuse treatment) (table 2). Screening methods include asking patients about behaviors associated with transmission of HIV and other STDs, eliciting patient reports of symptoms of other STDs, and laboratory testing for other STDs.

Table 2

Recommendations for screening human immunodeficiency virus (HIV)-infected persons for HIV transmission risk.

Table 2

Recommendations for screening human immunodeficiency virus (HIV)-infected persons for HIV transmission risk.

Behavioral risk screening should address both sex-related and injection drug—related behaviors (table 3). Screening can be done with brief, self-administered, written questionnaires; computer-, audio-, and video-assisted questionnaires; structured face-to-face interviews; and personalized discussions [5–16]. Screening questions can be either open-ended or closed (directed) (table 4). Open-ended questions avoid simple “yes” or “no” responses and encourage patients to discuss personal risks and the circumstances in which risks occur [6, 17, 18]. Clinicians who receive training are more likely to perform effective behavioral risk screening [8–11]. Screening for behavioral risks can be done by ancillary staff before the patient is seen by the clinician or by the clinician during the medical encounter. Provider reminder systems (e.g., computerized reminders) increase the likelihood that recommended screening is done regularly [19].

Table 3

Sex-related and injection-drug—related behaviors to address in behavioral risk screening.

Table 3

Sex-related and injection-drug—related behaviors to address in behavioral risk screening.

Table 4

Examples of screening strategies to elicit patient-reported risk for human immunodeficiency virus (HIV) transmission.

Table 4

Examples of screening strategies to elicit patient-reported risk for human immunodeficiency virus (HIV) transmission.

The presence of new STDs often suggests recent or ongoing sexual behaviors that may result in HIV transmission. Also, substantial evidence suggests that many STDs enhance risk for HIV transmission or acquisition [20–24]; therefore, early detection and treatment of bacterial STDs may reduce risk for HIV transmission [25]. Clinicians should routinely ask patients about STD symptoms; the presence of such symptoms should always prompt diagnostic testing and, when appropriate, treatment. However, clinical symptoms are not sensitive for identifying many infections, because most STDs are asymptomatic [26–33]; therefore, laboratory screening (i.e., testing on the basis of risk estimation, regardless of clinical indications for testing) of HIV-infected persons is a cornerstone of identifying persons at risk for transmitting HIV and other STDs to others (tables 5 and 6) [34–37].

Table 5

Examples of laboratory screening strategies to detect asymptomatic sexually transmitted diseases.

Table 5

Examples of laboratory screening strategies to detect asymptomatic sexually transmitted diseases.

Table 6

Available diagnostic testing for detection of sexually transmitted diseases (STDs).

Table 6

Available diagnostic testing for detection of sexually transmitted diseases (STDs).

Women of childbearing age should be questioned during routine visits about the possibility of pregnancy. Women who suspect pregnancy or have missed their menses should be tested for pregnancy. Early pregnancy diagnosis would benefit even women not receiving antiretroviral treatment, because they could be offered treatment to decrease risk for perinatal HIV transmission.

Behavioral Interventions

Behavioral interventions are strategies designed to change the knowledge, attitudes, behaviors, or practices of individuals to reduce their personal health risks or their risk of transmitting HIV to others (table 7). Behavioral change can be facilitated by environmental cues in the clinic or office, messages delivered to patients by clinicians or other qualified staff on-site, or referral to other persons or organizations providing prevention services.

Table 7

Recommendations for behavioral interventions to reduce human immunodeficiency virus (HIV) transmission risk.

Table 7

Recommendations for behavioral interventions to reduce human immunodeficiency virus (HIV) transmission risk.

Clinic or office environments can be structured to support prevention. All patients should receive printed information about HIV transmission risks and preventing transmission of HIV to others. Information can be conveyed throughout the clinic; for example, posters and other visual cues containing prevention messages can be displayed in examination rooms and waiting rooms. These materials usually can be obtained through health department HIV/AIDS and STD programs or from the National Prevention Information Network (NPIN) (telephone: 1-800-458-5231; Web site: http://www.cdcnpin.org).

All HIV-infected patients can benefit from brief prevention messages emphasizing the need for safer behaviors to protect their own health and that of their sex or needle-sharing partners. Such messages include discussion of the patient's responsibility for appropriate disclosure of HIV serostatus to sex and needle-sharing partners. These messages can be delivered by clinicians, nurses, social workers, case managers, or health educators. Many patients have inadequate information about factors influencing HIV transmission and methods for preventing transmission. They should understand that the most effective methods for preventing HIV transmission remain those that protect noninfected persons against exposure to HIV. For sexual transmission, the only certain means for HIV-infected persons to prevent transmission to noninfected persons are sexual abstinence or sex only with a partner known to be already infected with HIV. However, restricting sex to partners of the same serostatus does not protect against transmission of other STDs or the possibility of HIV superinfection unless condoms of latex, polyurethane, or other synthetic materials are consistently and correctly used. For injection-related transmission, the only certain means for HIV-infected persons to prevent transmission to noninfected persons are abstaining from injection drug use or refraining from sharing injection equipment (e.g., syringes, needles, cookers, cottons, and water).

Some sexual behaviors have a lower average per-act risk for transmission than others [38–52], and replacing a higher risk behavior with a relatively lower risk behavior may reduce the likelihood that HIV transmission will occur (table 8) [44, 53, 54]. However, risk for HIV transmission is affected by numerous biological and behavioral factors [44, 54, 55], and estimates of the absolute per-episode risk for transmission associated with different activities may be misleading when applied to a specific patient or situation [49, 52]. High viral load is an important risk factor for HIV transmission (table 9) [56–65]. By lowering viral load, antiretroviral therapy may reduce risk for HIV transmission. However, since HIV can be detected in the semen, rectal secretions, female genital secretions, and pharynx of HIV-infected patients with undetectable plasma viral loads [66–70], all patients receiving therapy, even those with undetectable plasma HIV levels, should understand that they may still be able to transmit HIV. Few data are available on efficacy of postexposure prophylaxis for nonoccupational exposure [71–77]; thus, the potential availability of postexposure prophylaxis should not be used to justify risky behavior.

Table 8

Estimated per-act relative risk (RR) for a person without human immunodeficiency virus (HIV) infection acquiring HIV infection, based on sex act and condom use.

Table 8

Estimated per-act relative risk (RR) for a person without human immunodeficiency virus (HIV) infection acquiring HIV infection, based on sex act and condom use.

Table 9

Adjusted rate ratios of the risk for transmission and acquisition of human immunodeficiency virus type 1 (HIV-1) among discordant partners.

Table 9

Adjusted rate ratios of the risk for transmission and acquisition of human immunodeficiency virus type 1 (HIV-1) among discordant partners.

Interventions tailored to individual patients' risks can be delivered to patients at highest risk for transmitting HIV infection and for acquiring new STDs. This includes patients whose risk screening indicates current behaviors that may lead to transmission, who have a current or recent STD, or who mention issues of concern in discussions with the clinician [78, 79]. Any positive results of screening for behavioral risks or STDs should be addressed in more detail with the patient so a more thorough risk assessment can be done and an appropriate risk-reduction plan discussed and agreed upon. At a minimum, an appropriate referral should be made (table 10) and the patient should be informed of risks involved in continuing the behavior. HIV-infected persons who remain sexually active should understand that the only certain means for preventing transmission to noninfected persons is to restrict sex to HIV-infected partners. For mutually consensual sex with persons of unknown or discordant serostatus, consistent and correct use of condoms made of latex, polyurethane, or other synthetic materials can significantly reduce risk for HIV transmission. HIV-infected patients who continue injection drug use should understand the risks of sharing needles and be provided information regarding substance abuse treatment and access to clean needles (table 11) [80–82]. Examples of targeted motivational messages on condom use and needle sharing are provided (figures 1 and 2).

Table 10

Examples of which concerns to address and which to refer.

Table 10

Examples of which concerns to address and which to refer.

Table 11

Examples of messages that should be communicated to drug users who continue to inject.

Table 11

Examples of messages that should be communicated to drug users who continue to inject.

Figure 1

Examples of tailoring messages regarding condom use for sexually active, HIV-infected persons. This is not a comprehensive list of all questions that could be asked.

Figure 1

Examples of tailoring messages regarding condom use for sexually active, HIV-infected persons. This is not a comprehensive list of all questions that could be asked.

Figure 2

Examples of tailoring messages regarding needle sharing for HIV-infected persons who continue to inject drugs. This is not a comprehensive list of all questions that could be asked.

Figure 2

Examples of tailoring messages regarding needle sharing for HIV-infected persons who continue to inject drugs. This is not a comprehensive list of all questions that could be asked.

Prevention messages can be reinforced by subsequent longer or more intensive interventions in clinic or office environments by nurses, social workers, or health educators, if feasible [6, 83–108]. Many patients have underlying issues that impede adoption of safer behaviors, and achieving behavioral change is often dependent on addressing such issues. Clinicians will usually not have time or resources to fully address these issues, many of which can best be addressed through referrals for services such as intensive HIV prevention interventions (e.g., multisession risk-reduction counseling) [109–126], medical services (e.g., family planning and contraceptive counseling, substance abuse treatment), mental health services (e.g., treatment for sexual compulsivity), and social services (e.g., housing, protection from domestic violence) (table 10). Patients who have difficulty initiating or sustaining behaviors that reduce or prevent HIV transmission may benefit from prevention case management (PCM). PCM provides intensive, client-centered risk assessment; prevention counseling; and assistance accessing other services to address issues that affect patients' health and ability to change risk-taking behavior.

For IDUs, ceasing injection drug use is the only reliable way to eliminate risk for injection-associated HIV transmission; however, many IDUs are unable to sustain abstinence without substance abuse treatment. Early entry and maintenance in substance abuse treatment programs and sustained abstinence from injecting are important for reducing risk for HIV transmission from infected IDUs [127–143]. Some IDUs are not able or willing to stop injecting drugs; for these persons, once-only use of sterile syringes can significantly reduce risk for injection-related HIV transmission [144–153]. Information on access to sterile syringes and safe syringe disposal may be obtained through health departments or HIV/AIDS prevention programs.

Referrals that match the patient's self-identified priorities are more likely to be successful than those that do not. Discussion with the patient can identify factors that may make it difficult for the patient to complete the referral (e.g., lack of transportation). Patients need specific information to successfully access referral services and may need assistance (e.g., scheduling appointments) to complete referrals. When a clinician does not have the capacity to make all appropriate referrals, or when needs are complex, a case manager can help make referrals and coordinate care. Referral guides and other information usually can be obtained from health department HIV/AIDS prevention and care programs (table 12).

Table 12

Suggested contents for referral resource guide.

Table 12

Suggested contents for referral resource guide.

Clinicians can prepare to deliver HIV prevention messages and behavioral interventions by developing strategies for incorporating risk-reduction interventions into patients' clinic visits [154], obtaining training [155–158], becoming familiar with interventions that have demonstrated effectiveness [159], and becoming familiar with community resources. Training on risk screening and prevention can be obtained at CDC-funded STD/HIV Prevention Training Centers (http://depts.washington.edu/nnptc) and HRSA-funded AIDS Education and Training Centers (http://www.aids-ed.org). Additional information related to behavioral interventions is available through many health department HIV/AIDS programs. A complete listing of state AIDS directors is available from the National Alliance of State and Territorial AIDS Directors (NASTAD) (http://www.nastad.org). Examples of case scenarios for prevention counseling are provided in tables 13–16.

Table 13

Case scenario 1.

Table 13

Case scenario 1.

Table 16

Case scenario 4.

Table 16

Case scenario 4.

Partner Counseling and Referral Services, Including Partner Notification

Many HIV-infected persons are not aware of their infection; thus, they cannot benefit from early medical care and do not know they may be transmitting HIV to others. Reaching such persons as early after infection as possible is important for their health and for reducing HIV transmission. Partner counseling and referral services (PCRS), including partner notification, are intended to address these problems by (1) providing services to HIV-infected persons and their sex and needle-sharing partners so the partners can take steps to avoid becoming infected or infecting others, and (2) helping infected partners gain earlier access to medical care and other services (table 17) [160].

Table 17

Recommendations for partner counseling and referral services, including partner notification.

Table 17

Recommendations for partner counseling and referral services, including partner notification.

A key element of PCRS involves informing current and past partners that they have been exposed to HIV and advising them to have HIV counseling and testing [161–164]. PCRS is confidential and voluntary. Partners can be reached and informed of their exposure by the infected person, clinicians in the private sector, or health department staff. Notification by the health department appears to be substantially more effective than notification by the infected person [96]. Also, one observational study suggested health department specialists were more successful than physicians in interviewing patients and locating partners [165]. Health departments have staff who are trained to do partner notification and skilled at providing this free, confidential service. These specialists can work closely with public and private sector clinicians who treat persons with HIV and other STDs. Most states and some cities or localities have laws and regulations related to informing partners they have been exposed to HIV. Clinicians should know and comply with such requirements. Additional information related to PCRS is available through health department HIV/AIDS programs.

The HIV Prevention in Clinical Care Working Group

Members of the working group. Sevgi Aral, Samuel W. Dooley, Mary L. Kamb, Jonathan Kaplan, Mary Spink Neumann, Ida M. Onorato, Thomas A. Peterman, Kathryn J. Rauch, Renee Ridzon, and J. Walton Senterfitt (Centers for Disease Control and Prevention [CDC], Atlanta, GA); Barbara Aranda-Naranjo and Michael Johnson (Health Resources and Services Administration [HRSA], Rockville, MD); Christopher M. Gordon (National Institutes of Health, [NIH] Rockville, MD); and, for the HIV Medical Association of the Infectious Diseases Society of America [HIVMA of the IDSA], John Bartlett (The Johns Hopkins University School of Medicine, Baltimore, MD).

Consultants to the working group. Representing the HIVMA of the IDSA: Fredrick Hecht (University of California, San Francisco AIDS Program, San Francisco, California) and Kenneth Mayer (Brown University School of Medicine, Providence, Rhode Island).

Federal government staff: Joanna Buffington, James Buehler, Alan E. Greenberg, Kathleen Irwin, Harold W. Jaffe, Robert S. Janssen, Gary Marks, Allyn Nakashima, Esther Sumartojo, Ronald O. Valdiserri, Jason Urbanowicz, Richard Wolitski, Kimberly Workowski (CDC, Atlanta, GA); Kim W. Hamlett-Berry (Department of Veterans Affairs, Washington, DC).

Other consultants: Bruce D. Agins (New York State Department of Health AIDS Institute, New York, NY), H. Hunter Handsfield (University of Washington and Public Health-Seattle and King County, Seattle, WA) King K. Holmes (University of Washington, Seattle, WA), Thomas C. Quinn (The Johns Hopkins University School of Medicine, Baltimore, MD), Julie M. Scofield (National Alliance of State and Territorial AIDS Directors, Washington, DC), and Dan Wohlfeiler (California Department of Public Health, Berkeley, CA).

Acknowledgments

The preparers of this article are grateful to P. Lynne Stockton and P. Susanne Justice (CDC, Atlanta, GA), for their editorial assistance, and to Mark R. Vogel (HIVMA of the IDSA, Alexandria, VA), who assisted in coordinating responses from members of the HIVMA of the IDSA.

References

1
Centers for Disease Control and Prevention
Guidelines for national human immunodeficiency virus case surveillance, including monitoring for human immunodeficiency virus infection and acquired immunodeficiency syndrome
MMWR Morb Mortal Wkly Rep
 , 
1999
, vol. 
48
 
RR-13
(pg. 
1
-
27
29-31
2
Janssen
RS
Holtgrave
DR
Valdiserri
RO
Shepherd
M
Gayle
HD
The serostatus approach to fighting the HIV epidemic: prevention strategies for infected individuals
Am J Public Health
 , 
2001
, vol. 
91
 (pg. 
1019
-
24
)
3
Institute of Medicine, Committee on HIV Prevention Strategies in the United States
Ruiz
MS
Gable
AR
Kaplan
EH
Stoto
MA
Fineberg
HV
Trussell
J
No time to lose: getting more from HIV prevention
 , 
2001
Washington, DC
National Academy Press
4
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
MMWR Morb Mortal Wkly Rep
 , 
2003
, vol. 
52
 
RR-12
(pg. 
1
-
24
Available at: http://www.cdc.gov/mmwr/mmwr_rr.html. Accessed 3 November 2003
5
Gerbert
B
Bronstone
A
Pantilat
S
, et al.  . 
When asked, patients tell: disclosure of sensitive health-risk behaviors
Med Care
 , 
1999
, vol. 
37
 (pg. 
104
-
11
)
6
Centers for Disease Control and Prevention
Revised guidelines for HIV counseling, testing, and referral
MMWR Morb Mortal Wkly Rep
 , 
2001
, vol. 
50
 
RR-19
(pg. 
1
-
57
)
7
Wight
RG
Rotheram-Borus
MJ
Klosinski
L
Ramos
B
Calabro
M
Smith
R
Screening for transmission behaviors among HIV-infected adults
AIDS Educ Prev
 , 
2000
, vol. 
12
 (pg. 
431
-
41
)
8
Rabin
DL
Boekeloo
BO
Marx
ES
Bowman
MA
Russell
NK
Willis
AG
Improving office-based physicians' prevention practices for sexually transmitted diseases
Ann Intern Med
 , 
1994
, vol. 
121
 (pg. 
513
-
9
)
9
DeGuzman
MA
Ross
MW
Assessing the application of HIV and AIDS related education and counselling on the Internet
Patient Education and Counseling
 , 
1999
, vol. 
36
 (pg. 
209
-
28
)
10
Fredman
L
Rabin
DL
Bowman
M
, et al.  . 
Primary care physicians' assessment and prevention of HIV infection
Am J Prev Med
 , 
1989
, vol. 
5
 (pg. 
188
-
95
)
11
Orlander
JD
Samet
JH
Kazis
L
Freeberg
KA
Libman
H
Improving medical residents' attitudes toward HIV-infected persons through training in an HIV staging and triage clinic
Acad Med
 , 
1994
, vol. 
69
 (pg. 
1001
-
3
)
12
Sullivan
L
Stein
MD
Savetsky
JB
Samet
JH
The doctor-patient relationship and HIV-infected patients' satisfaction with primary care physicians
J Gen Intern Med
 , 
2000
, vol. 
15
 (pg. 
462
-
9
)
13
Boekeloo
BO
Schiavo
L
Rabin
DL
Conlon
RT
Jordan
CS
Mundt
DJ
Self-reports of HIV risk factors by patients at a sexually transmitted disease clinic: audio vs. written questionnaires
Am J Public Health
 , 
1994
, vol. 
84
 (pg. 
754
-
60
)
14
Webb
PM
Zimet
GD
Fortenberry
JD
Blythe
MJ
Comparability of a computer-assisted versus written method for collecting health behavior information from adolescent patients
J Adolesc Health
 , 
1999
, vol. 
24
 (pg. 
383
-
8
)
15
Kissinger
P
Rice
J
Farley
T
, et al.  . 
Application of computer-assisted interviews to sexual behavior research
Am J Epidemiol
 , 
1999
, vol. 
149
 (pg. 
950
-
4
)
16
Metzger
DS
Koblin
B
Turner
C
, et al.  . 
Randomized controlled trial of audio computer-assisted self-interviewing: utility and acceptability in longitudinal studies. HIVNET Vaccine Preparedness Study Protocol Team
Am J Epidemiol
 , 
2000
, vol. 
152
 (pg. 
99
-
106
)
17
Risk reduction: sex without condoms
HIV Counselor Perspectives [newsletter]
 , 
2001
, vol. 
Vol. 10
 
No. 2
(pg. 
1
-
8
March
18
California STD Controllers Association, California Coalition of Local AIDS Directors
Guidance for STD clinical preventive services for persons infected with HIV
Sex Transm Dis
 , 
2001
, vol. 
28
 (pg. 
460
-
3
)
19
Hopkins
DP
Briss
PA
Ricard
CJ
, et al.  . 
Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke
Am J Prev Med
 , 
2001
, vol. 
20
 (pg. 
16
-
66
)
20
Fleming
DT
Wasserheit
JN
From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection
Sex Transm Infect
 , 
1999
, vol. 
75
 (pg. 
3
-
17
)
21
Grosskurth
H
Mosha
F
Todd
J
, et al.  . 
Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomized controlled trial
Lancet
 , 
1995
, vol. 
346
 (pg. 
530
-
6
)
22
Wasserheit
JN
Epidemiological synergy: interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases
Sex Transm Dis
 , 
1992
, vol. 
19
 (pg. 
61
-
77
)
23
Cohen
MS
Sexually transmitted diseases enhance HIV transmission: no longer a hypothesis
Lancet
 , 
1998
, vol. 
351
 (pg. 
5
-
7
)
24
Quinn
TC
Association of sexually transmitted diseases and infection with the human immunodeficiency virus: biological cofactors and markers of behavioural interventions
Int J STD AIDS
 , 
1996
, vol. 
7
 (pg. 
17
-
24
)
25
Centers for Disease Control and Prevention
HIV prevention through early detection and treatment of other sexually transmitted diseases—United States: ecommendations of the Advisory Committee for HIV and STD Prevention
MMWR Morb Mortal Wkly Rep
 , 
1998
, vol. 
47
 
RR-12
(pg. 
1
-
24
)
26
Kamb
ML
Newman
D
Peterman
TA
, et al.  . 
Most bacterial STD are asymptomatic [abstract 266]
Program and abstracts of STIs at Millennium, Past, Present, and Future: a Joint Meeting of the ASTDA and the MSSVD (Baltimore, Maryland)
 , 
2000
27
Phillips
RS
Hanff
PA
Wertheimer
A
Aronson
MD
Gonorrhea in women seen for routine gynecologic care: criteria for testing
Am J Med
 , 
1988
, vol. 
85
 (pg. 
177
-
82
)
28
Schachter
J
Stoner
E
Moncada
J
Screening for chlamydial infections in women attending family planning clinics
West J Med
 , 
1983
, vol. 
138
 (pg. 
375
-
9
)
29
Handsfield
HH
Lipman
TO
Harnisch
JP
Tronca
E
Holmes
KK
Asymptomatic gonorrhea in men. Diagnosis, natural course, prevalence, and significance
N Engl J Med
 , 
1974
, vol. 
290
 (pg. 
117
-
23
)
30
Alexander-Rodriguez
T
Vermund
SH
Gonorrhea and syphilis in incarcerated urban adolescents: prevalence and physical signs
Pediatrics
 , 
1987
, vol. 
80
 (pg. 
561
-
4
)
31
Ellerbeck
EF
Vlahov
D
Libonati
JP
Salive
ME
Brewer
TF
Gonorrhea prevalence in the Maryland state prisons
Sex Transm Dis
 , 
1989
, vol. 
16
 (pg. 
165
-
7
)
32
Grosskurth
H
Mayaud
P
Mosha
F
, et al.  . 
Asymptomatic gonorrhea and chlamydial infection in rural Tanzanian men
BMJ
 , 
1996
, vol. 
312
 (pg. 
277
-
80
)
33
Mehta
SD
Rothman
RE
Kelen
GD
Quinn
TC
Zenilman
JM
Unsuspected gonorrhea and chlamydia in patients of an urban adult emergency department: a critical population for STD control intervention
Sex Transm Dis
 , 
2001
, vol. 
28
 (pg. 
33
-
9
)
34
Mayer
KH
Klausner
JD
Handsfield
HH
Intersecting epidemics and educable moments: sexually transmitted disease risk assessment and screening in men who have sex with men
Sex Transm Dis
 , 
2001
, vol. 
28
 (pg. 
464
-
7
)
35
Centers for Disease Control and Prevention
Sexually transmitted diseases treatment guidelines 2002
MMWR Morb Mortal Wkly Rep
 , 
2002
, vol. 
51
 
RR-6
(pg. 
1
-
78
)
36
STD Control Program, HIV/AIDS Control Program, Public Health, Seattle and King County
Sexually transmitted disease and HIV screening guidelines for men who have sex with men
Sex Transm Dis
 , 
2001
, vol. 
28
 (pg. 
457
-
9
)
37
Centers for Disease Control and Prevention
Screening tests to detect Chlamydia trachomatis and Neisseria gonorrheae infections 2002
MMWR Morb Mortal Wkly Rep
 , 
2002
, vol. 
51
 
RR-15
(pg. 
1
-
38
)
38
Peterman
TA
Stoneburner
RL
Allen
JR
Jaffe
HW
Curran
JW
Risk of human immunodeficiency virus transmission from heterosexual adults with transfusion associated infections
JAMA
 , 
1988
, vol. 
259
 (pg. 
55
-
8
)
39
DeGruttola
V
Seage
GR
III
Mayer
KH
Horsburgh
CR
Jr
Infectiousness of HIV between male homosexual partners
J Clin Epidemiol
 , 
1989
, vol. 
42
 (pg. 
849
-
56
)
40
Johnson
AM
Petherick
A
Davidson
SJ
, et al.  . 
Transmission of HIV to heterosexual partners of infected men and women
AIDS
 , 
1989
, vol. 
3
 (pg. 
367
-
72
)
41
Laga
M
Taelman
H
Van der Stuyft
P
Bonneux
L
Vercauteren
G
Piot
P
Advanced immunodeficiency as a risk factor for heterosexual transmission of HIV
AIDS
 , 
1989
, vol. 
3
 (pg. 
361
-
6
)
42
Wiley
JA
Herschkorn
SJ
Padian
NS
Heterogeneity in the probability of HIV transmission per sexual contact: the case of male-to-female transmission in penile-vaginal intercourse
Stat Med
 , 
1989
, vol. 
8
 (pg. 
93
-
102
)
43
Padian
NS
Shiboski
SC
Jewell
NP
Female-to-male transmission of human immunodeficiency virus
JAMA
 , 
1991
, vol. 
266
 (pg. 
1664
-
7
)
44
European Study Group on Heterosexual Transmission of HIV
Comparison of female to male and male to female transmission of HIV in 563 stable couples
BMJ
 , 
1992
, vol. 
304
 (pg. 
809
-
13
)
45
Saracco
A
Musicco
M
Nicolosi
A
, et al.  . 
Man-to-women sexual transmission of HIV: longitudinal study of 343 steady partners of infected men
J Acquir Immune Defic Syndr
 , 
1993
, vol. 
6
 (pg. 
497
-
502
)
46
De Vincenzi
I
A longitudinal study of human immunodeficiency virus transmission by heterosexual partners
N Engl J Med
 , 
1994
, vol. 
331
 (pg. 
341
-
6
)
47
Nicolosi
A
Correa Leite
ML
Musicco
M
Arici
C
Gavazzeni
G
Lazzarin
A
The efficiency of male-to-female and female-to-male sexual transmission of the human immunodeficiency virus: a study of 730 stable couples. Italian Study Group on HIV Heterosexual Transmission
Epidemiology
 , 
1994
, vol. 
5
 (pg. 
570
-
5
)
48
Nicolosi
A
Musicco
M
Saracco
A
Lazzarin
A
Risk factors for woman-to-man sexual transmission of the human immunodeficiency virus. Italian Study Group on Heterosexual Transmission
J Acquir Immune Defic Syndr
 , 
1994
, vol. 
7
 (pg. 
296
-
300
)
49
Downs
AM
De Vincenzi
I
Probability of heterosexual transmission of HIV: relationship to the number of unprotected sexual contacts
J Acquir Immune Defic Syndr Hum Retrovirol
 , 
1996
, vol. 
11
 (pg. 
388
-
95
)
50
Padian
NS
Shiboski
SC
Glass
SO
Vittinghoff
E
Heterosexual transmission of human immunodeficiency virus in Northern California: results from a ten-year study
Am J Epidemiol
 , 
1997
, vol. 
146
 (pg. 
350
-
7
)
51
Leynaert
B
Downs
AM
De Vincenzi
I
Heterosexual transmission of human immunodeficiency virus: variability of infectivity throughout the course of infection. European Study Group on Heterosexual Transmission of HIV
Am J Epidemiol
 , 
1998
, vol. 
148
 (pg. 
88
-
96
)
52
Vittinghoff
E
Douglas
J
Judson
F
McKirnan
D
MacQueen
K
Buchbinder
SP
Per-contact risk of human immunodeficiency virus transmission between male sexual partners
Am J Epidemiol
 , 
1999
, vol. 
150
 (pg. 
306
-
11
)
53
Varghese
B
Maher
JE
Peterman
TA
Branson
BM
Steketee
RW
Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use
Sex Transm Dis
 , 
2002
, vol. 
29
 (pg. 
38
-
43
)
54
Macaluso
JM
Kelaghan
J
Artz
L
, et al.  . 
Mechanical failure of the latex condom in a cohort of women at high STD risk
Sex Transm Dis
 , 
1999
, vol. 
26
 (pg. 
450
-
8
)
55
Royce
RA
Sena
A
Cates
W
Jr
Cohen
MS
Sexual transmission of HIV
N Engl J Med
 , 
1997
, vol. 
336
 (pg. 
1072
-
8
)
56
Schaffer
N
Roongpisuthipong
A
Siriwasin
W
, et al.  . 
Maternal virus load and perinatal human immunodeficiency virus type 1, subtype E transmission, Thailand. Bangkok Collaborative Perinatal HIV Transmission Study Group
J Infect Dis
 , 
1999
, vol. 
179
 (pg. 
590
-
9
)
57
Mofenson
LM
Lambert
JS
Stiehm
ER
, et al.  . 
Risk factors for perinatal transmission of human immunodeficiency virus type 1 in women treated with zidovudine. Pediatric AIDS Clinical Trials Group Study 185 Team
N Engl J Med
 , 
1999
, vol. 
341
 (pg. 
385
-
93
)
58
Garcia
PM
Kalish
LA
Pitt
J
, et al.  . 
Maternal levels of plasma human immunodeficiency virus type 1 RNA and the risk of perinatal transmission. Women and Infants Transmission Study Group
N Engl J Med
 , 
1999
, vol. 
341
 (pg. 
394
-
402
)
59
Busch
MP
Operskalski
EA
Mosley
JW
, et al.  . 
Factors influencing human immunodeficiency virus type 1 transmission by blood transfusion. Transfusion Safety Study Group
J Infect Dis
 , 
1996
, vol. 
174
 (pg. 
26
-
33
)
60
Operskalski
EA
Stram
DO
Busch
MP
, et al.  . 
Role of viral load in heterosexual transmission of human immunodeficiency virus type 1 by blood transfusion recipients
Am J Epidemiol
 , 
1997
, vol. 
146
 (pg. 
655
-
61
)
61
Lee
TH
Sakahara
N
Fiebig
E
Busch
MP
O'Brien
TR
Herman
SA
Correlation of HIV-1 RNA levels in plasma and heterosexual transmission of HIV-1 from infected transfusion recipients
J Acquir Immune Defic Syndr Hum Retrovirol
 , 
1996
, vol. 
12
 (pg. 
427
-
8
)
62
Ragni
MV
Faruki
H
Kingsley
LA
Heterosexual HIV-1 transmission and viral load in hemophilic patients
J Acquir Immune Defic Syndr Hum Retrovirol
 , 
1998
, vol. 
17
 (pg. 
42
-
5
)
63
Gray
RH
Wawer
MJ
Brookmeyer
R
, et al.  . 
Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1 discordant couples in Rakai, Uganda
Lancet
 , 
2001
, vol. 
357
 (pg. 
1149
-
53
)
64
Chakraborty
H
Sen
PK
Helms
RW
, et al.  . 
Viral burden in genital secretions determines male-to-female sexual transmission of HIV-1: a probabilistic empiric model
AIDS
 , 
2001
, vol. 
15
 (pg. 
621
-
7
)
65
Quinn
TC
Wawer
MJ
Sewankambo
N
, et al.  . 
Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group
N Engl J Med
 , 
2000
, vol. 
342
 (pg. 
921
-
9
)
66
Collis
TK
Celum
CL
The clinical manifestations and treatment of sexually transmitted diseases in human immunodeficiency virus-positive men
Clin Infect Dis
 , 
2001
, vol. 
32
 (pg. 
611
-
22
)
67
Zhang
H
Dornadula
G
Beumont
M
, et al.  . 
Human immunodeficiency virus type 1 in the semen of men receiving highly active antiretroviral therapy
N Engl J Med
 , 
1998
, vol. 
339
 (pg. 
1803
-
9
)
68
Kiviat
NB
Critchlow
CW
Hawes
SE
, et al.  . 
Determinants of human immunodeficiency virus DNA and RNA shedding in the anal-rectal canal of homosexual men
J Infect Dis
 , 
1998
, vol. 
177
 (pg. 
571
-
8
)
69
Lampinen
TM
Critchlow
CW
Kuypers
JM
, et al.  . 
Association of antiretroviral therapy with detection of HIV-1 RNA and DNA in the anorectal mucosa of homosexual men
AIDS
 , 
2000
, vol. 
14
 (pg. 
69
-
75
)
70
Kovacs
A
Wasserman
SS
Burns
D
, et al.  . 
Determinants of HIV-1 shedding in the genital tract of women. WIHS Study Group
Lancet
 , 
2001
, vol. 
358
 (pg. 
1593
-
601
)
71
Centers for Disease Control and Prevention
Management of possible sexual, injecting-drug use, or other nonoccupational exposure to HIV, including considerations related to antiretroviral therapy. Public Health Service Statement
MMWR Morb Mortal Wkly Rep
 , 
1998
, vol. 
47
 
RR-17
(pg. 
1
-
14
)
72
Centers for Disease Control and Prevention
Public Health Service guidelines for management of health-care worker exposures to HIV and recommendations for postexposure prophylaxis
MMWR Morb Mortal Wkly Rep
 , 
1998
, vol. 
47
 
RR-7
(pg. 
1
-
33
)
73
Katz
MH
Gerberding
JL
Postexposure treatment of people exposed to human immunodeficiency virus through sexual contact or injection-drug use
N Engl J Med
 , 
1997
, vol. 
336
 (pg. 
1097
-
100
)
74
Katz
MH
Gerberding
JL
The care of persons with recent sexual exposure to HIV
Ann Intern Med
 , 
1998
, vol. 
128
 (pg. 
306
-
12
)
75
Bamberger
JD
Waldo
CR
Gerberding
JL
Katz
MH
Postexposure prophylaxis for human immunodeficiency virus (HIV) infection following sexual assault
Am J Med
 , 
1999
, vol. 
106
 (pg. 
323
-
6
)
76
Wiebe
ER
Comay
SE
McGregor
M
Ducceschi
S
Offering HIV prophylaxis to people who have been sexually assaulted: 16 months' experience in a sexual assault service
Canadian Medical Association Journal
 , 
2000
, vol. 
162
 (pg. 
641
-
5
)
77
Schecter
M
Lago
RF
Ismerio
R
Mendelsohn
AB
Harrison
LH
Acceptability, behavioral impact, and possible efficacy of post-sexual-exposure chemoprophylaxis (PEP) for HIV [abstract 15]
Program and abstracts of the 9th Conference on Retroviruses and Opportunistic Infections (Seattle, Washington)
 , 
2002
78
Coury-Doniger
P
Levenkron
JC
Knox
KL
Cowell
S
Urban
MA
Use of stage of change (SOC) to develop an STD/HIV behavioral intervention: phase 1: system to classify SOC for STD/HIV sexual risk behaviors—development and reliability in an STD clinic
AIDS Patient Care and STDs
 , 
1999
, vol. 
13
 (pg. 
493
-
502
)
79
Temmerman
M
Moses
S
Kiragu
D
, et al.  . 
Impact of single-session post-partum counseling of HIV infected women on their subsequent reproductive behavior
AIDS Care
 , 
1990
, vol. 
2
 (pg. 
247
-
52
)
80
US Department of Health and Human Services
Medical advice for persons who inject illicit drugs
HIV Prevention Bulletin. Centers for Disease Control and Prevention, Health Resources and Services Administration, National Institute on Drug Abuse, National Institutes of Health, Substance Abuse and Mental Health Services Administration. May
 , 
1997
 
Available at: http://www.cdc.gov/idu/pubs/hiv_prev.htm. Accessed 12 November 2003
81
Academy for Educational Development
A comprehensive approach: preventing blood-borne infections among injection drug users
 , 
2001
Washington, DC
Academy for Educational Development
 
Available at http://www.cdc.gov/idu/pubs/ca/comprehensive-approach.htm. Accessed 12 November 2003
82
Library for AIDS/HIV Resources
The two most complete ways to clean injecting drug works
HIV Connect
 , 
1993
, vol. 
11
 pg. 
10
 
83
Allen
S
Serufilira
A
Bogaerts
J
, et al.  . 
Confidential HIV testing and condom promotion in Africa. Impact on HIV and gonorrhea rates
JAMA
 , 
1992
, vol. 
268
 (pg. 
3338
-
43
)
84
Kalichman
SC
Rompa
D
Cage
M
, et al.  . 
Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people
Am J Prev Med
 , 
2001
, vol. 
21
 (pg. 
84
-
92
)
85
Kamb
ML
Fishbein
M
Douglas
JM
Jr
, et al.  , 
Project RESPECT Study Group
Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial
JAMA
 , 
1998
, vol. 
280
 (pg. 
1161
-
7
)
86
Mansfield
CJ
Conroy
ME
Emans
SJ
Woods
ER
Pilot study of AIDS education and counseling of high-risk adolescents in an office setting
J Adolesc Health
 , 
1993
, vol. 
14
 (pg. 
115
-
9
)
87
O'Donnell
CR
O'Donnell
L
San Doval
A
Duran
R
Labes
K
Reductions in STD infections subsequent to an STD clinic visit: using video-based patient education to supplement provider interactions
Sex Transm Dis
 , 
1998
, vol. 
25
 (pg. 
161
-
8
)
88
O'Donnell
L
San Doval
A
Duran
R
O'Donnell
CR
Effectiveness of video-based interventions in promoting condom acquisition among STD clinic patients
Sex Transm Dis
 , 
1995
, vol. 
22
 (pg. 
97
-
103
)
89
Cohen
D
Dent
C
MacKinnon
D
Condom skills education and sexually transmitted disease reinfection
J Sex Res
 , 
1991
, vol. 
28
 (pg. 
139
-
44
)
90
Cohen
DA
MacKinnon
DP
Dent
C
Mason
HR
Sullivan
E
Group counseling at STD clinics to promote use of condoms
Public Health Rep
 , 
1992
, vol. 
107
 (pg. 
727
-
30
)
91
Wenger
NS
Greenberg
JM
Hilborne
LH
Kusseling
F
Mangotich
M
Shapiro
MF
Effect of HIV antibody testing and AIDS education on communication about HIV risk and sexual behavior. A randomized, controlled trial in college students
Ann Intern Med
 , 
1992
, vol. 
117
 (pg. 
905
-
11
)
92
Hobfoll
SE
Jackson
AP
Lavin
J
Britton
P
Shepherd
JB
Reducing inner-city women's AIDS risk activities: a study of single, pregnant women
Health Psychol
 , 
1994
, vol. 
13
 (pg. 
397
-
403
)
93
St Kelly
JA
Lawrence JS, Hood HV, Brasfield TL. Behavioral intervention to reduce AIDS risk activities
J Consult Clin Psychol
 , 
1989
, vol. 
57
 (pg. 
60
-
7
)
94
Kelly
JA
Murphy
DA
Washington
CD
, et al.  . 
The effects of HIV/AIDS intervention groups for high-risk women in urban clinics
Am J Public Health
 , 
1994
, vol. 
84
 (pg. 
1918
-
22
)
95
Grella
CD
Annon
JJ
Anglin
MD
Ethnic differences in HIV risk behaviors, self-perceptions, and treatment outcomes among women in methadone maintenance treatment
J Psychoactive Drugs
 , 
1995
, vol. 
27
 (pg. 
421
-
33
)
96
Landis
SE
Schoenbach
VJ
Weber
DJ
, et al.  . 
Results of a randomized trial of partner notification in cases of HIV infection in North Carolina
N Engl J Med
 , 
1992
, vol. 
326
 (pg. 
101
-
6
)
97
Lie
GT
Biswalo
PM
HIV-positive patient's choice of a significant other to be informed about the HIV-test result: findings from an HIV/AIDS counselling programme in the regional hospitals of Arusha and Kilimanjaro, Tanzania
AIDS Care
 , 
1996
, vol. 
8
 (pg. 
285
-
96
)
98
Müller
O
Sarangbin
S
Ruxrungtham
K
Sittitrai
W
Phanuphak
P
Sexual risk behavior reduction associated with voluntary HIV counseling and testing in HIV infected patients in Thailand
AIDS Care
 , 
1995
, vol. 
7
 (pg. 
567
-
72
)
99
Allen
S
Serufilira
A
Gruber
V
, et al.  . 
Pregnancy and contraception use among Rwanda women after HIV testing and counseling
Am J Public Health
 , 
1993
, vol. 
83
 (pg. 
705
-
10
)
100
Fawzy
FI
Namir
S
Wolcott
DL
Structured group intervention model for AIDS patients
Psychiatr Med
 , 
1989
, vol. 
7
 (pg. 
35
-
45
)
101
Hedge
B
Glover
LF
Group intervention with HIV seropositive patients and their partners
AIDS Care
 , 
1990
, vol. 
2
 (pg. 
147
-
54
)
102
Hjorther
A
Nielsen
FM
Segest
E
Prevention of AIDS: free condoms to drug abusers in the municipality of Copenhagen
Int J Addict
 , 
1990
, vol. 
25
 (pg. 
745
-
53
)
103
Guydish
J
Temoshok
L
Dilley
J
Rinaldi
J
Evaluation of a hospital based substance abuse intervention and referral service for HIV affected patients
Gen Hosp Psychiatry
 , 
1990
, vol. 
12
 (pg. 
1
-
7
)
104
Rao
AV
Swaminathan
R
Baskaran
S
Belinda
C
Andal
G
Saleem
K
Behaviour change in HIV infected subjects following health education
Indian J Med Res
 , 
1991
, vol. 
93
 (pg. 
345
-
9
)
105
Ryder
RW
Batter
VL
Nsuami
M
, et al.  . 
Fertility rates in 238 HIV-1 seropositive women in Zaire followed for 3 years post-partum
AIDS
 , 
1991
, vol. 
5
 (pg. 
1521
-
7
)
106
Centers for Disease Control and Prevention
HIV prevention through case management for HIV-infected persons—selected sites, United States, 1989–1992
MMWR Morb Mortal Wkly Rep
 , 
1993
, vol. 
42
 (pg. 
448
-
9
455-6
107
Ladner
J
Leroy
V
Msellati
P
, et al.  . 
Cohort study of factors associated with failure to return for HIV post-test counselling in pregnant women: Kigali, Rwanda, 1992–1993
AIDS
 , 
1996
, vol. 
10
 (pg. 
69
-
75
)
108
Pickering
J
Quigley
M
Pepin
J
Todd
J
Wilkins
A
Effects of post-test counselling on condom use among prostitutes in The Gambia
AIDS
 , 
1993
, vol. 
7
 (pg. 
271
-
3
)
109
DiClemente
RJ
Wingood
GM
A randomized controlled trial of an HIV sexual risk-reduction intervention for young African-American women
JAMA
 , 
1995
, vol. 
274
 (pg. 
1271
-
6
)
110
El-Bassel
N
Schilling
RF
15-Month follow-up of women methadone patients taught skills to reduce heterosexual HIV transmission
Public Health Rep
 , 
1992
, vol. 
107
 (pg. 
500
-
4
)
111
Jemmott
JB
III
Jemmott
LS
Fong
GT
Reductions in HIV risk-associated sexual behaviors among black male adolescents: effects of an AIDS prevention intervention
Am J Public Health
 , 
1992
, vol. 
82
 (pg. 
372
-
7
)
112
McCusker
J
Stoddard
AM
Zapka
JG
Morrison
CS
Zorn
M
Lewis
BF
AIDS Education for drug abusers: evaluation of short-term effectiveness
Am J Public Health
 , 
1992
, vol. 
82
 (pg. 
533
-
40
)
113
Rotheram-Borus
M
Van Rossem
R
Lee
M
, et al.  . 
Reductions in HIV risk among runaway youths
Prevention Science
  
(in press)
114
Shain
RN
Piper
JM
Newton
ER
, et al.  . 
A randomized, controlled trial of a behavioral intervention to prevent sexually transmitted disease among minority women
N Engl J Med
 , 
1999
, vol. 
340
 (pg. 
93
-
100
)
115
Stanton
BF
Li
X
Ricardo
I
Galbraith
J
Feigelman
S
Kaljee
L
A randomized, controlled effectiveness trial of an AIDS prevention program for low-income African-American youths
Arch Pediatr Adolesc Med
 , 
1996
, vol. 
150
 (pg. 
363
-
72
)
116
St. Lawrence
JS
Brasfield
TL
Jefferson
KW
Alleyne
E
O'Bannon
RE
III
Shirley
A
Cognitive-behavioral intervention to reduce African-American adolescents' risk for HIV infection
J Consult Clin Psychol
 , 
1995
, vol. 
63
 (pg. 
221
-
37
)
117
Wenger
NS
Linn
LS
Epstein
M
Shapiro
MF
Reduction of high-risk sexual behavior among heterosexuals undergoing HIV antibody testing: a randomized clinical trial
Am J Public Health
 , 
1991
, vol. 
81
 (pg. 
1580
-
5
)
118
Valdiserri
RO
Lyter
DW
Leviton
LC
Callahan
CM
Kingsley
LA
Rinaldo
CR
AIDS prevention in homosexual and bisexual men: results of a randomized trial evaluating two risk reduction interventions
AIDS
 , 
1989
, vol. 
3
 (pg. 
21
-
6
)
119
Coates
TJ
McKusick
L
Kuno
R
Stites
DP
Stress reduction training changed number of sexual partners but not immune function in men with HIV
Am J Public Health
 , 
1989
, vol. 
79
 (pg. 
885
-
7
)
120
Kelly
JA
Murphy
DA
Bahr
GR
, et al.  . 
Outcome of cognitive-behavioral and support group brief therapies for depressed, HIV-infected persons
Am J Psychiatry
 , 
1993
, vol. 
150
 (pg. 
1679
-
86
)
121
Darrow
WW
Webster
RD
Kurtz
SP
Buckley
AK
Patel
KI
Stempel
RR
Impact of HIV counseling and testing on HIV-infected men who have sex with men: the South Beach Health Survey
AIDS and behavior
 , 
1998
, vol. 
2
 (pg. 
115
-
26
)
122
Parsons
JT
Huszti
HC
Crudder
SO
Rich
L
Mendoza
J
Maintenance of safer sexual behaviors: evaluation of a theory based intervention for HIV seropositive men with haemophilia and their female partners
Haemophilia
 , 
2000
, vol. 
6
 (pg. 
181
-
90
)
123
Perry
SW
Card
CA
Moffatt
M
Ashman
T
Fishman
B
Jacobsberg
LB
Self-disclosure of HIV infection to sexual partners after repeated counseling
AIDS Educ Prev
 , 
1994
, vol. 
6
 (pg. 
403
-
11
)
124
Pomeroy
EC
Rubin
A
Van Lamingham
L
Walker
RJ
“Straight Talk”: the effectiveness of a psychoeducational group intervention for heterosexuals with HIV/AIDS
Research on Social Work Practice
 , 
1997
, vol. 
7
 (pg. 
149
-
64
)
125
Turnbull
PJ
Dolan
KA
Stimson
GV
HIV testing, and the care and treatment of HIV positive people in English prisons
AIDS Care
 , 
1993
, vol. 
5
 (pg. 
199
-
206
)
126
Wong-Rieger
D
David
L
Causal evaluation of impact of support workshop for HIV+ men
Can J Public Health
 , 
1993
, vol. 
84
 (pg. 
66
-
70
)
127
Gibson
DR
Flynn
NM
McCarthy
JJ
Effectiveness of methadone treatment in reducing HIV risk behavior and HIV seroconversion among injecting drug users
AIDS
 , 
1999
, vol. 
13
 (pg. 
1807
-
18
)
128
National Institutes of Health (NIH) Consensus Development Program
Effective medical treatment of opiate addiction: NIH Consensus statement online
 , 
1997
, vol. 
15
 (pg. 
1
-
38
Available at: http://odp.od.nih.gov/consensus/cons/108/108_statement.htm. Accessed 12 November 2003
129
National Institute on Drug Abuse
Principles of drug addiction treatment: a research-based guide
National Institutes of Health publication no. 99-4180
 , 
1999
Rockville, MD
US Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse
130
Ball
JC
Lange
WR
Meyers
CP
Friedman
SR
Reducing the risk of AIDS through methadone maintenance treatment
J Health Soc Behav
 , 
1988
, vol. 
29
 (pg. 
214
-
26
)
131
Metzger
DS
Woody
GE
McLellan
AT
, et al.  . 
Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of treatment: an 18-month prospective follow-up
J Acquir Immune Defic Syndr
 , 
1993
, vol. 
6
 (pg. 
1049
-
56
)
132
Moss
AR
Vranizian
K
Gorter
R
Bacchetti
P
Watters
J
Osmond
D
HIV seroconversion in intravenous drug users in San Francisco, 1985–1990
AIDS
 , 
1994
, vol. 
8
 (pg. 
223
-
31
)
133
Neaigus
A
Sufian
M
Friedman
SR
, et al.  . 
Effects of an outreach intervention on risk reduction among intravenous drug users
AIDS Educ Prev
 , 
1990
, vol. 
2
 (pg. 
253
-
71
)
134
Shore
RE
Marmor
M
Titus
S
Des Jarlais
DC
Methadone maintenance and other factors associated with intraindividual temporal trends in injection-drug use
J Subst Abuse Treat
 , 
1996
, vol. 
13
 (pg. 
241
-
8
)
135
Wells
EA
Calsyn
DA
Clark
LL
Saxon
AJ
Jackson
TR
Retention in methadone maintenance is associated with reductions in different HIV risk behaviors for women and men
Am J Drug Alcohol Abuse
 , 
1996
, vol. 
22
 (pg. 
509
-
52
)
136
Zangerle
R
Fuchs
D
Rossler
H
, et al.  . 
Trends in HIV infection among intravenous drug users in Innsbruck, Austria
J Acquir Immune Defic Syndr
 , 
1992
, vol. 
5
 (pg. 
865
-
71
)
137
Condelli
WS
Dunteman
GH
Exposure to methadone programs and heroin use
Am J Drug Alcohol Abuse
 , 
1993
, vol. 
19
 (pg. 
65
-
78
)
138
Greenfield
L
Biglow
GE
Brooner
RK
Validity of intravenous drug abusers' self-reported changes in HIV high-risk drug use behaviors
Drug Alcohol Depend
 , 
1995
, vol. 
39
 (pg. 
91
-
8
)
139
Martin
GS
Serpelloni
G
Galvan
V
, et al.  . 
Behavioural change in injecting drug users: evaluation of an HIV/AIDS education programme
AIDS Care
 , 
1990
, vol. 
2
 (pg. 
275
-
9
)
140
Watkins
KE
Metzger
D
Woody
G
McLellan
AT
High-risk sexual behaviors of intravenous drug users in- and out-of-treatment: implications for the spread of HIV infection
Am J Drug Alcohol Abuse
 , 
1992
, vol. 
18
 (pg. 
389
-
98
)
141
Serpelloni
G
Carriere
MP
Rezza
G
Morganti
S
Gomma
M
Binkin
N
Methadone treatment as a determinant of HIV risk reduction among injecting drug users: a nested case controlled study
AIDS Care
 , 
1994
, vol. 
6
 (pg. 
215
-
20
)
142
Baker
A
Kochan
N
Dixon
J
Wodak
A
Heather
N
HIV risk-taking behaviour among injecting drug users currently, previously and never enrolled in methadone treatment
Addiction
 , 
1995
, vol. 
90
 (pg. 
545
-
54
)
143
Capelhorn
JR
Ross
MW
Methadone maintenance and the likelihood of risky needle sharing
Int J Addict
 , 
1995
, vol. 
30
 (pg. 
685
-
98
)
144
Gibson
DR
Flynn
NM
Perales
D
Effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users
AIDS
 , 
2001
, vol. 
15
 (pg. 
1329
-
41
)
145
Academy for Educational Development
Access to sterile syringes
 , 
2000
Washington, DC
Centers for Disease Control and Prevention
 
Available at: http://www.cdc.gov/idu. Accessed 12 November 2003
146
Cotten-Oldenburg
NU
Carr
P
DeBoer
JM
Collison
EK
Novotny
G
Impact of pharmacy-based syringe access on injection practices among injecting drug users in Minnesota
J Acquir Immune Defic Syndr
 , 
2001
, vol. 
27
 (pg. 
183
-
92
)
147
Gleghorn
AA
Wright-De Aguero
L
Flynn
C
Feasibility of one-time use of sterile syringes: a study of active injection drug users in seven United States metropolitan areas
J Acquir Immune Defic Syndr Hum Retrovirol
 , 
1998
, vol. 
18
 (pg. 
30
-
6
)
148
Burris
S
Lurie
P
Abrahamson
D
Rich
JD
Physician prescribing of sterile injection equipment to prevent HIV infection: time for action
Ann Intern Med
 , 
2000
, vol. 
133
 (pg. 
218
-
26
)
149
Rich
JD
Macalino
GE
McKenzie
M
Taylor
LE
Burris
S
Syringe prescription to prevent infection in Rhode Island: a case study
Am J Public Health
 , 
2001
, vol. 
91
 (pg. 
699
-
700
)
150
Groseclose
SL
Weinstein
B
Jones
TS
Valleroy
L
Fehrs
L
Kassler
WJ
Impact of increased legal access to needles and syringes on practices of injecting drug users and police officers: Connecticut, 1992–1993
J Acquir Immune Defic Syndr Hum Retrovirol
 , 
1995
, vol. 
10
 (pg. 
82
-
9
)
151
Gershon
RR
Infection control basis for recommending one-time use of sterile syringes and aseptic procedures for injection drug users
J Acquir Immune Defic Syndr Hum Retrovirol
 , 
1998
, vol. 
18
 (pg. 
20
-
4
)
152
Gleghorn
AA
Doherty
MC
Vlahov
D
Celentano
DD
Jones
TS
Inadequate bleach contact times during syringe cleaning among injection drug users
J Acquir Immune Defic Syndr
 , 
1994
, vol. 
7
 (pg. 
767
-
72
)
153
McCoy
CB
Rivers
JE
McCoy
HV
, et al.  . 
Compliance to bleach disinfection protocols among injecting drug users in Miami
J Acquir Immune Defic Syndr
 , 
1994
, vol. 
7
 (pg. 
773
-
6
)
154
Fisher
WA
Fisher
JD
Friedland
G
Cornman
D
Amico
R
The Options Project: a physician-delivered intervention for HIV+ individuals in clinical care settings [abstract 249]
Program and abstracts of the 2001 National HIV Prevention Conference (Atlanta, Georgia)
 , 
2001
pg. 
132
 
155
Dodge
WT
BlueSpruce
J
Grothaus
L
, et al.  . 
Enhancing primary care HIV prevention: a comprehensive clinical intervention
Am J Prev Med
 , 
2001
, vol. 
20
 (pg. 
177
-
83
)
156
Cornuz
J
Zellweger
JP
Mounoud
C
Decrey
H
Pecoud
A
Burnand
B
Smoking cessation counseling by residents in an outpatient clinic
Prev Med
 , 
1997
, vol. 
26
 (pg. 
292
-
6
)
157
DePoy
E
Burke
JP
Sherwen
L
Training trainers: evaluating services provided to children with HIV and their families
Research on Social Work Practice
 , 
1992
, vol. 
2
 (pg. 
39
-
55
)
158
Levinson
W
Cohen
MS
Brady
D
Duffy
FD
To change or not to change: “sounds like you have a dilemma”
Ann Intern Med
 , 
2001
, vol. 
135
 (pg. 
386
-
91
)
159
Centers for Disease Control and Prevention (CDC)
Compendium of HIV prevention interventions with evidence of effectiveness
 , 
1999
Atlanta, Georgia
US Department of Health and Human Services, CDC
 
(revised 2001). Available at: http://www.cdc.gov/hiv/pubs/hivcompendium/hivcompendium.htm. Accessed 1 December 2003
160
Macke
BA
Maher
JE
Partner notification in the United States: an evidence-based review
Am J Prev Med
 , 
1999
, vol. 
17
 (pg. 
230
-
42
)
161
Fenton
K
Peterman
TA
HIV partner notification: taking a new look
AIDS
 , 
1997
, vol. 
11
 (pg. 
1535
-
46
)
162
Centers for Disease Control and Prevention (CDC)
HIV partner counseling and referral services: guidance
 , 
1998
Atlanta, GA
US Department of Health and Human Services, CDC
 
Available at: http://www.cdc.gov/hiv/pubs/pcrs/pcrs-cov.htm. Accessed 12 November 2003
163
Centers for Disease Control and Prevention (CDC)
Program Operations. Guidelines for STD Prevention. Partner Services
 
Atlanta, GA
US Department of Health and Human Services, CDC
 
Updated June 28, 2001. Available at: http://www.cdc.gov/std/program/partners.pdf. Accessed 12 November 2003
164
Cowan
FM
French
R
Johnson
AM
The role and effectiveness of partner notification in STD control: a review
Genitourin Med
 , 
1996
, vol. 
72
 (pg. 
247
-
52
)
165
Giesecke
J
Ramstedt
K
Granath
F
Ripa
T
Rado
G
Westrell
M
Efficacy of partner notification for HIV infection
Lancet
 , 
1991
, vol. 
338
 (pg. 
1096
-
100
)

Figures and Tables

Table 14

Case scenario 2.

Table 14

Case scenario 2.

Table 15

Case scenario 3.

Table 15

Case scenario 3.

Author notes

a
The members of the HIV Prevention in Clinical Care Working Group are listed at the end of the text.

Comments

0 Comments