This analysis focuses on primary prevention for people living with HIV and the importance of actively involving HIV-infected people in developing prevention strategies. Structural-level or policy interventions - as opposed to behavioral or psychological interventions - help shape the world in which HIV-infected people live. Thus, we assess potential policy-level interventions that may serve either as a barrier to or a facilitator of primary HIV prevention from the perspective of the people living with HIV. Among potential barriers, we discuss criminalization of nondisclosure in specific sexual situations, laws limiting travel and immigration, name-based HIV reporting and mandatory partner notification. Under potential facilitators, we discuss confidentiality laws, antidiscrimination protections, expansion of HIV primary care, and primary prevention programs designed to actively involve infected people. Ultimately, whether any given policy is a 'barrier' or 'facilitator' of primary HIV prevention is an empirical question, dependent on the acceptability of an intervention to those already infected and those at risk, thus policy research evaluating the impact of structural factors on people living with HIV is encouraged.
From the University of California, San Francisco, California, USA.
Sponsorship: This analysis was supported in part by the UCSF Center for AIDS Prevention Studies, a grant from the National Institute of Mental Health (MH42459).
Note: This paper is dedicated to Chuck Frutchey, a pioneer. An earlier version of this paper was presented by M.D.S. at the Structural Barriers and Facilitators in HIV Prevention Meeting, Centers for Disease Control and Prevention, 22-23 February 1999.
Requests for reprints to: M.D. Shriver, AIDS Policy Research Center, University of California, San Francisco, 74 New Montgomery Street, Suite 600, San Francisco, CA 94105, USA.