The Centers for Disease Control and Prevention (CDC) has revised and greatly expanded guidelines addressing HIV prevention strategies for people living with the virus, aidsmap reports. The CDC has taken its 24-page 2003 “prevention with positives” document and expanded it into a 240-page tome that addresses biomedical prevention, the “treatment cascade,” the social and structural needs of people living with the virus, and which gives detailed advice for people with HIV looking to conceive children.

The CDC stresses the centrality of HIV-positive people in the effort to prevent new cases of the virus, pointing out that targeting them with prevention efforts is more likely to reduce HIV incidence than trying to change the behaviors of millions of people who are at risk.

The 2003 guidelines focused on screening for behavioral risk factors and sexually transmitted infections, partner notification, prevention counseling and behavioral interventions. The new guidelines broaden the scope to address issues such as poverty, mental illness, substance use or unstable housing that may indirectly increase the risk of transmission of the virus to others.

The CDC advises clinicians to encourage their HIV-positive patients to begin antiretroviral (ARV) treatment within three months of diagnosis, regardless of CD4 count. (Successful treatment with ARVs can apparently all but eliminate the chance of transmitting the virus.) Clinicians are also advised to counsel patients that immediate treatment will improve their own health and lifespan.

A major roadblock to effective biomedical prevention is the gaps in the “treatment cascade.” The CDC guidelines encourage interventions to improve linkage to care and retention in care in particular. Additionally, the CDC recommends that health departments use surveillance data to identify both individuals and populations who need assistance integrating into the health care system.

Health professionals are advised to assist people with HIV with finding insurance. They should also counsel patients about pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for HIV-negative people.

Men and women should receive counseling on how to reduce the risk of transmission while attempting to conceive a child.

The CDC remains relatively conservative with regards to state laws that criminalize HIV transmission, exposure or lack of disclosure. The CDC has not taken a stance against such widely maligned laws in the new guidelines, but recommends that health professionals counsel people with HIV about the existence of these laws.

To read the aidsmap story, click here.

To read the CDC guidelines, click here.