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sterilized equipment to injection drug users substantially reduces risk of HIV infection, increases
the probability that they will initiate drug treatment, and does not increase drug use.⁹⁰⁹¹
• HIV treatment: In addition to benefiting their own health, studies show that HIV-positive indi-
viduals who are adhering to effective antiretroviral therapy are less likely to transmit the virus
compared to HIV-positive individuals who are not on medication.⁹² There are also specific HIV
medications that a person can take immediately after being exposed to HIV that can reduce the
risk of HIV infection, called post exposure prophylaxis (PEP).⁹³ Antiretroviral therapy for pregnant
women with HIV also dramatically reduces the risk of HIV transmission during pregnancy and
childbirth.⁹⁴
Some other biomedical and behavioral interventions have not been consistently associated with
reducing HIV transmission, but may still contribute to our prevention efforts. For example, having
an untreated sexually transmitted infection (STI) such as herpes, gonorrhea or syphilis substantially
increases a person’s chance of acquiring HIV, but research has not yet shown that treating STIs lowers HIV
infection at a population level.⁹⁵ ⁹⁶ Nevertheless, all people screened for STIs should also be screened
for HIV infection because these infections are driven by the same risk behaviors.⁹⁷ Similarly, there are
scientifically proven behavioral interventions that reduce HIV risk behaviors such as sexual risk behavior
or drug use.⁹⁸ Even though these interventions have not been proven to reduce HIV infections, they
promote responsible sexual behaviors that may lower a person’s risk for becoming infected with HIV
and some have been associated with reducing STIs. ⁹⁹
,
¹⁰⁰
,
¹⁰¹ Not all of the interventions, however, are
equally effective over the long-term and not all of them are readily scalable, meaning that they can
be effectively and affordably disseminated to large groups of people. ¹⁰² Given limited resources and
substantial needs in communities heavily impacted by HIV, behavioral interventions that can effectively
reach large groups of individuals should be prioritized. Additionally, more operational research is needed
to determine which behavioral interventions are scalable and produce robust and sustainable outcomes.
90. Latkin, C, Davey, M, and Hua, W. Needle Exchange Program Utilization and Entry into Drug User Treatment: Is There a Long-
Term Connection in Baltimore, Maryland? Subst Use Misuse, 41(14):1991-2001.
91. Vlahov D, Junge B. The role of needle exchange programs in HIV prevention. Public Health Rep. 1998;113 (Suppl 1):75-80.
92. Donnell D, Baeten JM, Kiarie J, et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective
cohort analysis. Lancet. 2010.
93. Smith DK, Grohskopf LA, Black RJ, et al. Antiretroviral postesxposure prophylaxis after sexual, injection-drug use, or other
nonoccupational exposure to HIV in the United States. MMWR. 2005; 54:1-20.
94. HHS. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1 Infected Women for Maternal Health and
Interventions to Reduce Perinatal HIV Transmission in the United States. May 24, 2010
95. Celum C, Wald A, Hughes J, et al. Effect of acyclovir on HIV-1 acquisition in herpes simplex virus 2 seropositive women and
men who have sex with men. Lancet. 2008;371:2109-19.
96. Gray RH, Wawer MJ. Reassessing the hypothesis on STI control for Prevention. Lancet. 2008; 371(9630): 2064-2065.
97. National Alliance of State and Territorial AIDS Directors, National Coalition of STD Directors. STD/HIV prevention integration;
2002Available from: URL: http://www.ncsddc.org/docs/STDHIVIssuePaperFinal.pdf
98. CDC. 2009 compendium of evidence-based HIV prevention interventions. Available from URL:
http://www.cdc.gov/hiv/topics/research/prs/evidence-based-interventions.htm
99. Coates T, Richter L, Caceres C. Behavioural strategies to reduce HIV transmission: how to make them better. Lancet.
2008;372(9639):669-684.
100. Koblin B, Chesney M, Coates TJ, for the EXPLORE Study Team. Effects of a behavioural intervention to reduce acquisition of
HIV infection among men who have sex with men: the EXPLORE randomised controlled study. Lancet. 2004; 364: 41–50.
101. Crepaz N, Horn AK, Rama SM, et al. The efficacy of behavioral interventions in reducing HIV risk sex behaviors and incident
sexually transmitted disease in black and Hispanic sexually transmitted disease clinic patients in the United States: a meta-analytic
review. Sex Transm Dis. 2007;34(6):319-32.
102. Coates T, Richter L, Caceres C. Behavioural strategies to reduce HIV transmission: how to make them better. Lancet.
2008;372(9639):669-684.