PREVENTION

PREVENTION

To reduce the incidence of HIV, CDC released the Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings in 2006. These recommendations include the routine HIV screening of adults, adolescents, and pregnant women in health care settings in the United States. They also include reducing barriers to HIV testing. In 2003, CDC announced Advancing HIV Prevention. This initiative comprises 4 strategies: making HIV testing a routine part of medical care, implementing new models for diagnosing HIV infections outside medical settings, preventing new infections by working with HIV-infected persons and their partners, and further decreasing perinatal HIV transmission.

Given that a large number of HIV-infected MSM are unaware of their infection, HIV testing is an important strategy for this population. Many of these men have previously tested HIV-negative, so CDC recommends that all sexually active MSM be tested for HIV at least once a year [49]. MSM who engage in high-risk behaviors (e.g., unprotected anal sex with casual partners) should be tested more frequently.

MSM as a group continues to be the population most affected by HIV infection and AIDS. Howver, research shows that HIV prevention efforts can reduce sexual risk factors: one review found that among men who received an HIV prevention intervention, the proportion who engaged in unprotected sex decreased, on average, 26% [50].

CDC offers effective interventions for MSM (http://www.effectiveinterventions.org)Non-CDC Web Link. These interventions can be tailored to various audiences, such as African American or Hispanic MSM. For example,

* Many Men, Many Voices, which is a group STD/HIV prevention intervention for gay men of color and men who have sex with other men but do not identify themselves as gay or bisexual
* Mpowerment, which comprises HIV prevention, safer sex, and risk-reduction messages in a community-building format for young MSM
* Popular Opinion Leader, which involves identifying, enlisting, and training key opinion leaders to encourage safer sex as the norm in the social networks of MSM
* Healthy Relationships, which helps develop the skills and self-efficacy of MSM and other people living with HIV/AIDS
* Peers Reaching Out and Modeling Intervention Strategies (PROMISE), which uses peer advocates (including men who do not identify themselves as gay) to help people adopt practices to reduce or eliminate risk factors for HIV infection

In 2006, CDC provided 54 awards to community-based organizations that focus primarily on MSM. CDC also provides funding through state, territorial, and local health departments. Of these 54 awards, 63% focus on African Americans, 43% on Hispanics, 13% on Asians and Pacific Islanders, and 20% on whites (the percentages do not add to 100% because some of the organizations focus on more than one racial/ethnic group). For example,

* An organization in Jefferson County, Alabama, that provides a range of services, including individual counseling, community and street outreach, and interventions for African American men and Spanish-speaking men
* An organization in New York City that provides HIV/AIDS–related services, education, and research to Asian and Pacific Islander communities
* An organization offering HIV/AIDS services throughout Los Angeles and San Bernardino counties and San Diego that is committed to enhancing the health and well-being of the Latino community and other underserved communities through community education, prevention, mobilization, advocacy, and direct social services.