The concept of ‘positive prevention’ provides an opportunity to highlight the prevention needs of people who know their positive serostatus.
Ever since HIV testing was developed in the early days of the epidemic, the role of people living with HIV in HIV prevention has been an important aspect of the AIDS response. Following the advent of combination antiretroviral treatment which significantly prolongs life and improves quality of life for people living with HIV, there have been increasing calls to incorporate what is known as ‘positive prevention’ in the continuum of prevention and care programmes and services.
The concept of ‘positive prevention’ provides an opportunity to highlight the prevention needs of people who know their positive serostatus, and is a useful lens through which to understand the important linkages between prevention, treatment, care and support.
However, despite increasing funding directed towards positive prevention, there is a lack of clear understanding globally and regionally of the concept, objectives and programmatic features of ‘positive prevention’, either within the community and representatives of people living with HIV, or between civil society and other partners.
As a direct consequence, the Global Network of People living with HIV (GNP+) and UNAIDS are convening a technical consultation on 27-28 April 2009 in Tunisia on the subject to help develop a common understanding of ‘positive prevention’, as well as guidelines and action plans to inform policies and programmes.
The term ‘positive prevention’ itself will be discussed during the technical consultation as, even though it is the most commonly used term, other terms are also used by different organizations and programmes such as ‘Prevention and Care for People Living with HIV/AIDS’ or ‘prevention with HIV-positive people’.
Participants at the consultation will represent civil society, government agencies, UNAIDS Cosponsors and Secretariat and international development agencies. A majority of the participants will be people living with HIV as the conversation around positive prevention has too often occurred without the involvement of people living with HIV at the design stage and has led to significant shortcomings in most current approaches.
The technical consultation follows the significant Positive Leadership Summit held in Mexico in 2008 and is part of an ongoing process to ensure that positive prevention efforts are based on a solid consensus among positive people. To that end, experts will identify strategies to gather experiences and knowledge of stakeholders, in particular people living with HIV at regional, national and local levels.
If the prevention needs of positive people are to be adequately addressed, people who know they are living with HIV must be involved in defining and developing programmes.
It is expected that the meeting will facilitate the development of a set of principles that will guide the work of and partnerships between multilateral, bilateral, governmental and civil society organizations in designing positive prevention programmes. Participants will also develop recommendations on the scaling up of programmes and policies, informed by the local context.
“Positive prevention” programmes
Many HIV programmes worldwide seek to include people living with HIV in their prevention efforts. Diverse programmatic activities are undertaken, including support for self-help groups and community empowerment, counselling in the context of HIV testing or of family planning, engagement of positive people in education programming (e.g. in delivering personal testimonies), and behaviour change programming directed at HIV-positive people or discordant partners. The aims of these programming efforts vary widely, and are not always explicit or consistent. Quite often, positive prevention programmes have focused on HIV testing and so are seen as irrelevant to people who already know their serostatus. Most existing interventions focus almost entirely on preventing the onward transmission of HIV, which may be counter-productive to programmes intended to address prevention, care and support for HIV positive people in a holistic manner.
If the prevention needs of positive people are to be adequately addressed, people who know they are living with HIV must be involved in defining and developing programmes. A human rights approach combating stigma and discrimination is essential to the success of positive prevention. Positive prevention requires addressing social vulnerabilities such as poverty, gender-based violence, xenophobia and homophobia. It is also inextricably linked with access to treatment, care and support.
While most agree that among the measures of success of positive prevention is the reduction of HIV transmission, it is also widely felt that positive prevention should not be exclusively about preventing onward transmission of HIV. The discussion about positive prevention needs to explore the efforts of people who know they are living with HIV to learn and practice ways to promote their own health and prevent disease.
