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Socially-Integrated Transdisciplinary HIV Prevention

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Abstract

Current ideas about HIV prevention include a mixture of primarily biomedical interventions, socio-mechanical interventions such as sterile syringe and condom distribution, and behavioral interventions. This article presents a framework for socially-integrated transdisciplinary HIV prevention that may improve current prevention efforts. It first describes one socially-integrated transdisciplinary intervention project, the Transmission Reduction Intervention Project. We focus on how social aspects of the intervention integrate its component parts across disciplines and processes at different levels of analysis. We then present socially-integrated perspectives about how to improve combination antiretroviral treatment (cART) processes at the population level in order to solve the problems of the treatment cascade and make “treatment as prevention” more effective. Finally, we discuss some remaining problems and issues in such a social transdisciplinary intervention in the hope that other researchers and public health agents will develop additional socially-integrated interventions for HIV and other diseases.

Resumen

Las ideas actuales sobre prevención del VIH incluyen una mezcla de intervenciones biomédicas primariamente -, intervenciones socio-mecánicas tales como la distribución de jeringas estériles y preservativos e intervenciones conductuales. Este artículo presenta un marco transdisciplinario y socialmente integrado para la prevención del VIH que puede mejorar los esfuerzos de prevención actuales. En primer lugar, se describe un proyecto de intervención transdisciplinario socialmente integrado: Proyecto de Intervención para Reducción de Transmisión. Nos centramos en cómo los aspectos sociales de la intervención integran sus componentes en todas las disciplinas y los procesos en diferentes niveles de análisis. A continuación, presentamos las perspectivas socialmente integradas sobre cómo mejorar los procesos de tratamiento antirretroviral combinado (TARC) a nivel de la población con el fin de resolver los problemas de cascada de tratamiento y hacer “tratamiento como prevención” más eficaz. Finalmente, se discuten algunos problemas pendientes en la descrita intervención transdisciplinaria en la esperanza de que otros investigadores y agentes de salud pública desarrollen otras intervenciones socialmente integradas para el VIH y otras enfermedades.

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Notes

  1. Participants who are uninfected or have long-term infection are referred for prevention and clinical follow-up using locally standard techniques except that the research component of TRIP does recruit some of them for further study as comparison group members. To the extent that TRIP assists long-term infected people get into care, this has both medical and prevention benefits.

  2. This part of TRIP differs from contact tracing in that it recruits more broadly from people’s social networks than simply their direct injection or sexual partners; it focuses on early infection rather than just whether or not a person is infected; and in its network recruiting, it does not stop when it encounters and uninfected network member but continues to trace the network for at least one additional step. In addition, TRIP also includes community alerts and innovative efforts to get people with early infection into effective medical care and help them make effective use of it.

  3. LAg is calibrated to detect which antibody-positive people have been infected for (on average) up to 130 days since they seroconverted. Seroconversion confirmation dates may vary depending on the tests used, but 30–35 days is not unusual. TRIP may use a slightly higher optical density (ODn) cut-off point in order to extend the recency period we are using to 6 months after infection.

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Acknowledgments

We would like to thank Konstantin Dumchev of CDC-Ukraine for his assistance. We gratefully acknowledge support from National Institute on Drug Abuse Grants P30 DA11041 (Center for Drug Use and HIV Research); DP1 DA034989 (Preventing HIV Transmission by Recently-Infected Drug Users) and T32 DA007233; National Institutes of Health D43TW000233 funded by the Fogarty International Center; the Medical Research Council (United Kingdom) for funding GM with a Clinician Scientist Fellowship. Support for the Aristotle Project and several authors was provided by EU NSRF 2007-2013, by European Social Fund, Greek national resources and the Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or other funding agencies.

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Authors and Affiliations

  1. Institute of Infectious Diseases Research, National Development and Research Institutes, Inc., 71 West 23rd Street, 8th Floor, New York, NY, 10010, USA

    Samuel R. Friedman, Martin J. Downing Jr. & Georgios Nikolopoulos

  2. Behavioral Sciences Training in Drug Abuse Research Program Sponsored By Public Health Solutions and National Development and Research Institutes, Inc., New York, NY, USA

    Martin J. Downing Jr.

  3. International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine

    Pavlo Smyrnov, Liudmyla Slobodianyk & Tetyana I. Vasylyeva

  4. School of Public Health, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine

    Pavlo Smyrnov

  5. Hellenic Centre for Diseases Control and Prevention, Athens, Greece

    Georgios Nikolopoulos

  6. Department of Medicine, University of Chicago, Chicago, IL, USA

    John A. Schneider

  7. Department of Health Studies, University of Chicago, Chicago, IL, USA

    John A. Schneider & Britt Livak

  8. Department of Zoology, University of Oxford, Oxford, UK

    Gkikas Magiorkinis

  9. Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece

    Gkikas Magiorkinis, Dimitrios Paraskevis, Mina Psichogiou, Vana Sypsa & Angelos Hatzakis

  10. WHO Country Office, Kyiv, Ukraine

    Liudmyla Slobodianyk

  11. 1st Department of Internal Medicine, Propaedeutic, Laikon General Hospital, University of Athens, Athens, Greece

    Mina Psichogiou

  12. Psychiatric Department, Athens University Medical School, Athens, Greece

    Melpomeni M. Malliori

  13. Organization against Drugs (OKANA), Αverof 21, Athens, 10433, Greece

    Melpomeni M. Malliori

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  1. Samuel R. Friedman
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Correspondence to Samuel R. Friedman.

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Friedman, S.R., Downing, M.J., Smyrnov, P. et al. Socially-Integrated Transdisciplinary HIV Prevention. AIDS Behav 18, 1821–1834 (2014). https://doi.org/10.1007/s10461-013-0643-5

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