POSITIVE PREVENTION TARGETS PEOPLE who have tested HIV positive in order to reduce their risk of transmitting HIV to sexual and injection drug-using partners.

Differentiated from generalised prevention, which targets everyone at risk for hiv as well as those who are hiv infected but have not yet undergone hiv testing, positive prevention requires the target population to self disclose their hiv status in order to access prevention services. In this chapter, the history of positive prevention and its relevance to hiv prevention in South Africa's generalised hiv/aids epidemic is discussed, particularly with respect to continued hiv transmission risk behaviours. An overview of positive prevention interventions and how they can be adapted to the South African context is also provided. The chapter concludes with recommendations for integrating positive prevention within a comprehensive hiv prevention plan.

History of positive prevention

Throughout the first decade of the global recognition of the aids epidemics, there was little research into the hiv transmission risk behaviours of people who have tested hiv positive. In contrast to receiving an hiv negative test result, which rarely results in substantial behaviour change, most research shows that testing hiv positive is followed by dramatic reductions in unprotected sexual behaviour. Not all people who test hiv positive completely stop risky behaviour, with its potential for transmitting hiv to others. In spite of this there was little research throughout the early 1990s on those hiv positive individuals who continue to practise hiv transmission risk behaviours.