Sound Public Health Approaches to Knowing Exposure to HIV

 描述(由申请人提供)：在美国所有新的艾滋病毒感染中，大约有一半来自知道自己艾滋病毒阳性状态的人。在某些情况下，这些人告诉他们的伴侣他们的血清呈阳性，他们的伴侣同意性行为，假设有感染的风险。在其他情况下，合作伙伴没有得到通知。美国大多数州都通过了针对艾滋病毒的法律，规定PLH在没有事先披露他或她的艾滋病毒阳性状态的情况下与伴侣发生性行为是犯罪的。我们的 研究表明，将艾滋病毒暴露定为犯罪并不是有效的艾滋病毒预防干预措施。关于将艾滋病毒暴露定为犯罪的潜在有害影响(例如，增加污名、加强与艾滋病毒有关的歧视、阻止检测)，也存在挥之不去的关切。国家艾滋病毒/艾滋病战略建议，为了最大限度地减少将艾滋病毒暴露定为犯罪的潜在负面影响，并最大限度地扩大国家防止艾滋病毒传播的努力，我们必须确保艾滋病毒暴露法“支持我们目前对预防艾滋病毒[传播]艾滋病毒的最佳公共卫生做法的理解”。然而，据我们所知，还没有研究检查与这些人合作的机构--州和地方卫生部门--为这些人制定的实际干预努力。我们相信，这项拟议的研究将是美国第一个探索美国卫生部门如何识别、核实和干预正在或被认为正在从事有可能与未向其披露其艾滋病毒阳性状态的伴侣进行艾滋病毒传播的行为的PLH的研究。这项研究将确定卫生部门用来应对这一客户群体的各种干预措施，并将评估一个州卫生部门帮助将其他人置于感染风险中的PLH计划的有效性。后者将通过使用客户病例记录和综合艾滋病毒/性传播感染监测数据对科罗拉多州公共卫生和环境部与这一客户群体的干预努力的有效性进行初步量化分析来实现。

 DESCRIPTION (provided by applicant): Approximately half of all new HIV infections in the US arise from persons who are aware of their HIV- positive status. In some cases, these individuals have informed their partners of their positive serostatus and their partners have consented to sex assuming the risk of infection. In other cases, the partners have not been informed. The majority of US states have passed HIV-specific laws that make it a crime for PLH to engage in sexual activities with a partner without having first disclosed his or her HIV-positive status. Our research suggests that the criminalization of HIV exposure is not an effective HIV prevention intervention. There are also lingering concerns about the potential deleterious effects of the criminalization of HIV exposure (e.g., increasing stigma, reinforcing HIV-related discrimination, deterring testing). The National HIV/AIDS Strategy recommends that to minimize the potential negative effects of criminalizing HIV exposure and to maximize national efforts to prevent the spread of HIV, we must ensure that HIV exposure laws "support our current understanding of best public health practices for preventing [transmission of] HIV." Yet to our knowledge, no studies have examined the actual intervention efforts developed for these individuals by the agencies that work with them the most-state and local health departments. The proposed study will, we believe, be the first in the US to explore how US health departments identify, verify, and intervene with PLH who are, or are believed to be, engaging in behaviors that risk forward HIV transmission with partners to whom they have not disclosed their HIV-positive status. The study will identify the variety of interventions used in health departments to respond to this client group and will evaluate the effectiveness of one state health department's program to assist PLH who put others at risk of infection. The latter will be accomplished through a preliminary quantitative analysis, using client case records and integrated HIV/STI surveillance data, of the effectiveness of the Colorado Department of Public Health and Environment's intervention efforts with this client group.