Abstract
Recent advances in combination antiretroviral therapy have been encouraging. The advent of highly active antiretroviral therapy (HAART), a combination therapy that includes protease inhibitors, has revolutionized treatment and enhanced the prospects for survival for people living with human immunodeficiency virus (HIV).1 While HAART can markedly suppress HIV in plasma to undetectable levels, considerable uncertainty remains whether reductions in plasma levels correspond to decreased risk of transmission and whether treatment advantages can be sustained. Recent findings indicate that individuals undergoing treatment with HAART, with nondetectable HIV levels in plasma, may still have the virus present in seminal cells.2 Thus, the potential to sexually transmit HIV persists despite effective suppression of viral replication.3 From an international perspective, irrespective of the effectiveness of HAART in managing disease among people living with HIV in developed countries, the availability of HAART in less developed countries in all likelihood will be severely limited due to its prohibitive cost.
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References
Palella FJ Jr, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med 1998; 338:853–860.
Zhang H, Dornadula G, Beumont M, et al. Human immunodeficiency virus type 1 in the semen of men receiving highly active antiretroviral therapy. N Engl J Med 1989; 339:1803–1809.
Haase AT, Schacker TW. Potential for the transmission of HIV-1 despite highly active antiretroviral therapy. N Engl J Med 1998; 339:1846–1847.
Nathanson N. Harnessing research to control AIDS. Nature Med 1998; 1:880–881.
Baltimore D, Heilamn C. HIV vaccines: Prospects and challenges. Sci Am 1998; 279:98–103.
Interventions to prevent HIV Risk Behaviors. NIH Concensus Statement 1997 Feb 11–13; 15(2):1–41.
Coates TJ, Collins C. Preventing HIV infection. Sci Am 1998; 279:96–97.
Kalichman SC, Carey MP, Johnson BT. Prevention of sexually transmitted HIV infection: A meta-analytic review of the behavioral outcome literature. Ann Behav Med 1996; 18:6–15.
NIMH Multisite HIV Prevention Trial Group. The NIMH Multisite HIV prevention trial: Reducing HIV sexual risk behavior. Science 1998; 280:1889–1894.
Kamb ML, Fishbein M, Douglas JM, et al. EFficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: A randomized controlled trial. JAMA 1998; 280:1161–1167.
Sweat MD, Denison JA. Reducing HIV incidence in developing countries with structural and environmental interventions. AIDS 1995; 9:S251–S257.
Coates T.J. Strategies for modifying sexual behavior for primary and secondary prevention of HIV disease. J Consult Clin Psychol 1990; 58:57–69.
Kelly J, Murphy DA, Sikkemas KJ, Kalichman SC. Psychological interventions are urgently needed to prevent HIV infection: New priorities for behavioral research in the second decade of AIDS. Am Psychol 1993; 48:1023–1034.
Kelly JA, Murphy DA. Psychological interventions with AIDS and HIV: Prevention and treatment. J Consult Clin Psychol 1992; 60:476–485.
Eng TR, Butler WT, eds. The Hidden Epidemic. Confronting Sexually Transmitted Diseases. Washington, DC: National Academy Press; 1997.
Cohen MS. Sexually transmitted diseases enhance HIV transmission: No longer a hypothesis. Lancet 1998; suppl 3:5–7.
Kreiss JK, Willerford DM, Hensel M, et al. Association between cervical inflammation and cervical shedding of human immunodeficiency virus DNA. J Infect Dis 1994; 170:1597–1601.
Ghys PD, Frasen K, Diallo MO, et al. The associations between cervicovaginal HIV shedding, sexually transmitted diseases and immunosuppression in female sex workers in Abidjan, Cote d’Ivoire. AIDS 1997; 11: 85–93.
Moss GB, Overbaugh J, Welch M, et al. Human immunodeficiency virus DNA in urethral secretions in men: Association with gonococcal urethritis and CD4 depletion. J Infect Dis 1995; 172:1469–1474.
De Vincenzi I. A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. N Engl J Med 1994; 331:341–346.
Deschamps MM, Pape JW, Hafner A, Johnson W. Heterosexual transmission of HIV in Haiti. Ann Intern Med 1996; 125:324–330.
Cohen MS, Hoffman IF, Royce RA, et al. Reduction of concentration of HIV-1 in semen after treatment of urethritis: Implications for prevention of sexual transmission of HIV-1. Lancet 1997; 349:1868–1873.
Atkins MC, Carlin EM, Emery VC, et al. Fluctuations of HIV load in semen of HIV positive patients with newly acquired sexually transmitted diseases. Br Med J 1996; 313:341–342.
Wasserheit JN. Epidemiological synergy: Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992; 19:61–77.
Shain RN, Piper JN, Newton ER, et al. A randomized controlled trial of a behavioral intervention to prevent sexually transmitted disease among minority women. N Engl J Med 1999; 340:93–100.
Branson BM, Peterman TA, Cannon RO, et al. Group counseling to prevent sexually transmitted diseases and HIV: A randomized controlled trial. Sex Transm Dis 1998; 25:553–560.
Grosskurth H, Mosha F, Todd J, et al. Impact of improved treatment of sexually transmitted disease on HIV infection in rural Tanzania: Randomised controlled trial. Lancet 1995; 346:530–536.
Laga M. STD control for HIV prevention-It works. Lancet 1995; 346:518–519.
Gilson L, Mkanje R, Grosskurth H, et al. Cost-effectiveness of improved treatment services for sexually transmitted diseases in preventing HIV-1 infection in Mwanza Region, Tanzania. Lancet 1997; 350:1805–1809.
Cates W, Hinman AR. AIDS and absolutism: The demand for perfection in prevention. N Engl J Med 1992; 327: 492–494.
Peterson J, DiClemente RJ. Lessons learned from behavioral interventions: Caveats, gaps and implications. In: DiClemente RJ, Peterson J, eds. Preventing AIDS: Theories and Methods of Behavioral Interventions. New York: Plenum Press, 1994:319–322.
Valdiserri RO. Technology transfer: Achieving the promise of HIV prevention. In: Peterson JP, DiClemente RJ, eds. Handbook of HIV Prevention. Plenum Press; in press.
DiClemente RJ. Preventing sexually transmitted infections among adolescents: A clash of ideology and science. JAMA 1998; 279:1574–1575.
Hein K. Aligning science with politics and policy in HIV prevention. Science 1998; 280:1905–1906.
Zenilman JM, Weisman CS, Rampalo AM, et al. Condom use to prevent incident STD: The validity of self-reported condom use. Sex Transm Dis 1995; 22:15–21.
Ellish NJ, Weisman CS, Celentano D, Zenilman JM. Reliability of partner reports of sexual history in a heterosexual population at a sexually transmitted disease clinic. Sex Transm Dis 1996; 23:446–452.
Quinn TC. Association of sexually transmitted diseases and infection with the human immunodeficiency virus: Biological cofactors and markers of behavioral interventions. Int J STD AIDS 1996; 7(suppl 2):17–24.
Orr D. Urine-based diagnosis of sexually transmitted infections: A shift in paradigms. J Adolesc Health 1997; 20:3–5.
Smith KR, Ching S, Lee H, et al. Evaluation of ligase chain reaction for use with urine for identification of Neisseria gonorrhoeae in females attending a sexually transmitted disease clinic. J Clin Microbiol 1995; 33: 455–457.
Oh MK, Smith KR, O’Cain M, et al. Urine-based screening of adolescents in detention to guide treatment for gonococcal and chlamydial infections. Arch Pediatr Adolesc Med 1998; 152:52–56.
Lee HH, Chernesky MA, Schachter J, et al. Diagnosis of chlamydia trachomatis genitourinary infection in women by ligase chain reaction assay of urine. Lancet 1995; 345:213–216.
Chernesky MA, Lee HH, Schachter J, et al. Diagnosis of Chlamydia trachomatis urethral infection in symptomatic and asymptomatic men by testing first-void urine in a ligase chain reaction assay. J. Infect Dis 1994; 170:1308–1311.
Xu K, Glanton V, Johnson SR, et al. Detection of Neisseria gonorrhoeae infection by ligase chain reaction testing of urine among adolescent women with and without Chlamydia trachomatis infection. Sex Transm Dis 1998; 25: 533–538.
O’Leary A, DiClemente RJ, Aral S. Reflections on the design and reporting of STD/HIV behavioral intervention research. AIDS Educ Prey 1997; 9(suppl. A):1–14.
Kahn JG, Haynes Sanstad KC. The role of cost-effectiveness analysis in assessing HIV-prevention interventions. AIDS Public Policy J 1997; 12:21–30.
Holtgrave DR. Cost analysis and HIV prevention interventions. Am Psychol 1994; 49:1088–1089.
Holtgrave DR, ed. Handbook of Economic Evaluation of HIV Prevention Programs. New York: Plenum Press; 1998.
Holtgrave DR, Kelly JA. Preventing HIV/AIDS among high-risk urban women: The cost-effectiveness of a behavioral group intervention. Am J Public Health 1996; 86:1442–1445.
The Standards of Reporting Clinical Trials Group. A proposal for structured reporting of randomized clinical trials. JAMA 1994; 272:1926–1931.
Begg C, Cho M, Eastwood S, et al. Improving the quality of reporting of randomized controlled trials: The CONSORT Statement. JAMA 1996; 278:637–639.
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DiClemente, R.J. (2000). Looking Forward. In: Peterson, J.L., DiClemente, R.J. (eds) Handbook of HIV Prevention. Aids Prevention and Mental Health. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-4137-0_17
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DOI: https://doi.org/10.1007/978-1-4615-4137-0_17
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