Health-care providers must fight a two-front war if there is any hope of stopping the spread of HIV, according to one Western researcher.
William Fisher, cross-appointed between Psychology and Obstetrics and Gynecology, recently published a paper outlining the effectiveness of a bidirectional intervention approach with HIV-infected individuals in South Africa. His model stresses a supportive approach that encourages two things – an adherence to medication and safer sex practices.
“There has to be a combined behavioural and biomedical approach (to intervention) and we feel our research is highly compatible, and, in fact, compromises that approach,” Fisher said.
“Our work is in support of the very fervent wish of most people with HIV that the epidemic stop with them; that’s why the work is referred to as ‘Prevention With Positives.’”
Published in the Journal of Acquired Immunodeficiency Syndromes, the paper is the result of a five-year study of approximately 2,000 HIV-infected South Africans at 16 HIV care sites in KwaZulu Natal, South Africa. It was funded by the U.S. National Institutes of Health.
“Our HIV prevention intervention was designed to be low cost and sustainable in resource-constrained countries and was implemented by existing lay counsellors already on staff at each routine patient care visit,” Fisher said. “(Our model) was brief, and it was effective in substantially reducing unsafe sexual contacts by HIV-infected individuals with all partners, and specifically with partners who were HIV-negative or HIV-status unknown.”
Fisher has spent the better part of three decades working on the prevention of HIV infection with a variety of groups including university students, inner-city minority youth and HIV-infected persons across the United States.
People living with HIV infection are on the front end of an epidemic, he explained, in that all new cases come from those who are already infected. These individuals, regardless of the country in which they live, need a proper support system to ensure they are informed about the disease and its risks, drug benefits, as well as how the infection spreads.
“The two critical issues from a public health perspective in respect to people living with HIV are prevention and support of a desire not to transmit infection,” he said.
“It’s the provision of shoulder-to-shoulder interventions to provide support, skills, coaching and encouragement for HIV-infected folks to practice safer sex over the long run. That’s been absent. And the second issue is adherence to medication.”
Fisher, along with his brother, Jeffrey Fisher, and colleagues at Yale, the University of Connecticut and the Nelson Mandela School of Medicine at the University of KwaZulu Natal in Durban, South Africa, has been working on tackling both agenda items together for the last 15 years.
South Africa is the epicentre of the world for the HIV/AIDS epidemic, and targeting an intervention approach, where infection rates in childbearing women are close to 20 per cent, is crucial in curbing the spread of disease.
Fisher’s team set out to use existing clinical resources settings in South Africa. Working with care providers who come into regular contact with HIV-infected persons, they developed an approach that would help predict risky sexual behaviour in patients. In conversation with patients, with specific targeted questions, care providers would be able to determine what kind of support or information the patient needed to continue taking medication and continue safe sex practices.
Basically, the team encouraged behavioural coaching with HIV infected persons.
“We took advantage of the fact that untrained counselors are already on staff at HIV care settings. We trained them to deliver a brief intervention as part of every HIV care visit,” Fisher said.
Fisher’s team had a control group that received the standard methods of care in place of the intervention model. By the study’s end, individuals that were part of the intervention model group were more likely to stick to safer behaviours and taking their medication, he added.
“We saw a dramatic reduction in risky sexual behaviour. People in the usual care group also reduced risky behaviour but the intervention group was vastly stronger and vastly more rapid,” Fisher continued, noting there are now talks of widely implementing intervention methods.
“It’s a standard of care intervention that never ends.”