University of Western Ontario professor Bill Fisher has written a prescription for reducing the transmission of HIV infection and it’s caught the attention of the U.S. Centers for Disease Control and Prevention.
Fisher, a distinguished university professor in the departments of Psychology and Obstetrics and Gynaecology, has been working alongside his brother, Jeffrey Fisher, and others at the University of Connecticut and Yale University on an intervention program that would give HIV clinicians the tools to speak to patients about reducing risky sexual behaviour.
“Most HIV positive people deeply desire never to transmit this infection to anyone else, but there’s been a real gap in evidence-based methods for supporting their firm commitment to prevention,” he says.
Recently the work of the Fisher brothers and their colleagues has caught the attention of the U.S. Centers for Disease Control and Prevention, which included the study in the 2008 Compendium of Evidence-Based HIV Prevention Interventions.
The compendium is a list of the best behavioural HIV interventions that have been rigorously evaluated and proven to be effective in reducing incidences of HIV, sexually transmitted diseases or HIV-related risk behaviours and promotes safer behaviours.
In short, being included in the compendium gives the work of the Fisher brothers, and fellow researchers, a stamp of approval in reducing the spread of HIV. “It’s a validation,” he says.
Organizations and HIV care providers looking to implement prevention programs into their practices often turn to the compendium as a resource, says Fisher.
In spite of advances in HIV drug therapies, Fisher says there has been almost no focus on preventative strategies for people living with HIV.
Most programs have been designed to promote HIV prevention amongst non-infected populations.
“The development for anti-retroviral drugs for HIV people has been a dramatic and welcomed and lifesaving sea change in HIV care. Now that people with HIV are living long and relatively healthy lives, it’s important to support prevention to make sure the epidemic gets smaller and smaller,” he says.
Fisher and his co-investigators wanted to find a way to bridge clinical care for HIV patients with preventative counseling.
“We decided to link care for HIV-positive people, which now thankfully involves effective drugs to manage HIV disease, with prevention support,” he says.
The result was the Options/Opciones Project, which is a program based on conversations between the patient and physician about practicing safer sex. It is also called Opciones because the program can be delivered in Spanish.
During a routine visit to the clinic a doctor uses “motivational interviewing” to assess the patient’s sexual practices to prevent transmission of HIV, finding out the reasons behind their risk choices and challenging the patient to decrease these risks. Together, the physician and patient write a prevention prescription for engaging in safer sex.
Putting the theory into practice, a study was conducted between October 2000 and August 2003 involving 497 HIV-infected patients recruited from two HIV clinics in Connecticut. More than 20 HIV care clinicians were trained to deliver the Options/Opciones Project.
“At the end of the four or five years of study, we found that HIV transmission risk behaviour by the HIV positive patients who received the Options/Opciones intervention was reduced to almost nothing,” he says.
Among the HIV patients who did not receive the intervention as part of their standard care, the level of risky sexual behaviour increased over time as a result of “safer sex fatigue,” he adds.
Fisher and his colleagues have taken the Options/ Opciones program to eight HIV care centres in South Africa and Uganda. They also plan to spread the program throughout other areas in Africa.
The Options/ Opciones project can also be used for other areas of disease prevention, such as diabetes treatment, adds Fisher.
“This is a strong way of helping people manage risky behaviour,” he says. “It will change the way patients are treated.”