What Is The Next Era Of HIV Prevention?

HIV prevention has had two previous "eras" of prevention. When HIV/AIDS first broke, the primary message was "don’t get HIV or you’ll die." This era was before the time of effective medication (pre-1996). Once the field discovered some basic medications, the second era of HIV started where prevention attempts had an implicit assumption that we would be able to eradicate the spread of HIV.

However, today we need a third era of HIV prevention and I honestly don’t have the answer on what the new era should look like. We need an approach that affirms the importance of HIV prevention without using fear as the primary motivator. We also need to acknowledge the reality that HIV is no longer considered a deadly illness but is now a chronic illness. Don’t get me wrong; HIV is extremely serious, but, we might be able to learn from other prevention programs, smoking for example, in developing better HIV prevention.

We also need to see risky sexual behaviors as a symptom rather than the problem. Co-occurring problems such as drug and alcohol use, mental health concerns, sexual compulsivity, and poverty are but a few of the related issues that need to be addressed in prevention.

Please don’t start a flame-war by attacking other respondents, but I’d like to hear from you.
How do you think our community should move forward?

(Photo: Getty Images)

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Dr. Weston Edwards is a psychologist licensed by the Minnesota Board of Psychology. He specializes in individual, couple and group counseling and has specific experiences working with sexuality, spirituality, chemical dependency and mental-health issues. He is in private practice at the Sexual Health Institute Dr. Edwards is also on staff at the Pride Institute providing sexuality and chemical dependency treatment for the LGBT community. His first book “Living a Life I Love™: Healing sexual compulsivity, sexual addiction, sexual avoidance and other sexual concerns is now available. You can also reach him on Twitter at @wedwardsphd.

Do you have a question about sex you would like Dr. Edwards to answer?  Send us an email.  We promise to keep your name confidential.

Comments

[1_in_a_mil]

Nothing except a tool to remove the human sex drive or vaccine/cure will eliminate sexual HIV. Yeah, it's very admirable that people at least try something to reduce their risk of getting it. They *should* and all methods, as long as done with earnest, should be respected, as in principle they are all the same. Believe it or not. But no one, even those who so indoctrinated by "condom all the time every time" mantra, believe themselves to be invisible, should not be surprised or start the beloved blame game when this virus continues to be spread, as it will. We can move forward by accepting the fact that we as sexually active people, all play sexual russian roulette, with more or less chambers. I maintain my stance that 1 million dying of a illness is no worse than 1 dying of the same.

[brentsf]

A lot of the stigma surrounding HIV is a result of the previous eras' prevention messages. "Don't get HIV or you will die" put the fear of death into people -- it made it even scarier to try to connect with an HIV+ person for HIV- folks. The images of sick, emaciated men with KS spots in the literature, advertisements and movies not only put a personal fear of getting HIV into many people but also a fear the film industry used to their advantage: the fear of losing your partner to AIDS. Some feel that the risk to the heart that comes with falling in love with an HIV+ person is too great and questions come to mind: what happens if they get sick? Will I have to take care of them? Can I stand by while the virus destroys their immune system?

Today, effective treatment has downgraded HIV from a death sentence to a manageable, chronic illness. You don't have to worry about touching an HIV+ person. You don't have to worry about being sneezed on by an HIV+ person. If you practice safer sex, you don't really have to worry about getting HIV from your positive partner. Chances are good that, with proper treatment and preventative care, positive people will live a normal life expectancy and not have to worry about being diagnosed with AIDS and the opportunistic infections that come with it.

I'm HIV+. I was just diagnosed September 11, 2009. I believe that I'm going to live a long, healthy life. My doctors have assured me that with treatment this won't be any worse than diabetes. The difference is, there is no stigma attached to diabetes. No one would turn me down for a date because I had diabetes. Friends wouldn't stop calling because I had diabetes. No, the message of the third era of HIV prevention cannot use fear because that fear is why the stigma exists. We created the stigma we are now trying to erase. We should focus more on making safer sex more appealing than unprotected sex. We should lump HIV in with syphilis, gonorrhea, herpes and other STIs. What's hot about having to pop pills for the rest of your life? What's hot about having to get a painful shot in your butt? What's hot about pain while peeing? Nothing! The fact is, HIV can come along for the ride with STIs. Guys think now if they get gonorrhea they just pop a pill once and its gone. The same risky behavior that netted them that little bugger could also give them HIV. That's what we need to be thinking about and pushing.