What's the point of HIV prevention?

What’s the point of HIV prevention? Ford HicksonSigma Research, United Kingdom

Tackling Stigma: Pride, Prejudice and PreventionAustralian Federation of AIDS Organisations’ HIV Educators ConferenceSydney, June 2010.

Amount of riskNo risk Much risk

0

20

40

60

80

100Population risk profile

Amount of riskNo UAI last 12 mths UAI in last 12 mths

0

20

40

60

80

100Population risk profile (UK GMSS 1998)

Amount of riskNo UAI last 12 mths UAI in last 12 mths

0

20

40

60

80

100Population risk profile (UK GMSS 2008)

Amount of risk (UAI & Condom Failure)No UAI or CF

Thought neg onlyUnknown not pos

Known pos

0

20

40

60

80

100Population risk profile (Sydney HIM Study 2001-4)

O.3% O.7% 1.5% 5.3%

Jin et al. (2009) AIDS, 23: 243–252.

Annual HIV incidence

% of new infections

28%28%30%15%

Amount of risk (UAI & condom failure)No UAI

Negotiated safetyOther thought neg only

Unknown not posKnown pos

0

20

40

60

80

100Population risk profile (Sydney HIM Study 2001-4)

Jin et al. (2009) AIDS, 23: 243–252.

Amount of risk (UAI & condom failure)No AI

PAI onlyNegotiated safety

Other thought negUnknown not pos

Known pos

0

20

40

60

80

100Population risk profile (Sydney HIM Study 2001-4)

Jin et al. (2009) AIDS, 23: 243–252 and personal communication.

Contribution to population HIV risk

Prop

ortio

n of

pop

ulati

on

open relationships →

ejaculation into the body →using poppers →

anal intercourse →

← STI/HIV test & treat

← disclosure & negotiation

← condoms and lubricant

← PEP taking

0.5%0.4% 0.6%

have new sex partners → ← decline, defer or date new partners

deferring screening & treatment →

← monogamy

silence (or lies) →

no condoms →

← non-penetrative sex

not seeking PEP →

← withdrawal before ejaculation← not using poppers

The best sex?

• Unconfident of already having an STI• Immediate sex with a new partner• Silent sex• Open relationships• Anal intercourse• Bareback• Ejaculating into the body• Using poppers• Not seeking PEP

The best sex?

• Confident of not having an STI• No sex, deferred sex or pre-dated sex• Disclosed and discussed sex• Monogamous relationships• Without intercourse• With condoms• Ejaculating outside the body• Not using poppers• Seeking PEP afterwards

The best sex with least harm?

Confident or Unconfident of passing on an STI?Declined or deferred or Sex now with new partner?

Disclosed and discussed or Silent?Monogamous or Open relationships?Non-penetrative or Anal intercourse?

Condom or Bareback?Ejaculation in the body or Outside the body?

No poppers or Poppers?PEP or No PEP?

Together for Tomorrow!

www.sigmaresearch.org.uk