Current HIV Prevention Approaches and Strengths of Digital Health Coaching as an Alternative

12.01.19

The Centers for Disease Control and Prevention notes that HIV continues to be an important public health issue. In 2017, approximately 38,789 people in the U.S. were newly diagnosed with HIV and 17,803 were diagnosed with AIDS, which is caused by HIV. Many of the new HIV infections took place in young teens and adults. More than half of those who acquired HIV were Black, Latino, and White men.  

The good news is that new HIV diagnoses are decreasing over time. In fact, This is due, in part, to innovative prevention programs used to address the needs of individuals at higher risk of acquiring HIV. These programs target various populations and needs. They are integral to slowing down and eventually eliminating HIV.

HIV is often a minimized public health issue — one that can only be fixed through sexual or injection drug use behavioral changes. However, systemic factors related to HIV, including poverty, racism, unemployment, limited social support, and stigma towards members of the LGBTQIA+ community make it even more difficult, or sometimes impossible, to sustainably alter behavior. 

Despite these difficulties, prevention programs are available to provide education, support, and encouragement to decrease HIV risk, and in turn, reduce the incidence of AIDS. In recognition of World AIDS Day, and in the spirit of prevention, I’m outlining some of the many programs currently provided to diverse populations. Additional information on all the programs outlined, as well as a more comprehensive offering,  can be found on the CDC’s website.

HIV Prevention Programs: A Brief Overview

Prevention Strategy: PrEP

Description: PrEP is a medication that helps adults and teens prevent HIV transmitted through sexual intercourse or intravenous drug use equipment sharing. This technique requires a pill to be taken daily as prescribed to reduce risk. PrEP resources and information can be found in health departments, community-based organizations, and healthcare organizations. 

Evidence: When you take PrEP as prescribed, you significantly lower your risk of contracting HIV. Studies have shown that PrEP, when taken daily, reduces HIV risk from sex by about 99% and by at least 74% among people who inject drugs. 

Prevention Strategy: Many Men, Many Voices (3MV) 

Description: A 7-session, group-level prevention program to prevent HIV and sexually transmitted diseases (STDs) among African American same gender loving (SGL) men and those who may or may not identify as gay. This program addresses many factors that influence behaviors including cultural, social and religious norms. The program seeks to enhance self-esteem related to racial identity and sexual behavior, education about HIV risk, and risk reduction strategies.

Evidence: A report in 2014 evaluated the efficacy of 3MV during a randomized control trial design. The study included 164 men who participated in the 3MV study with the intervention condition. These men showed a reduction of HIV/STD risk behaviors including: number of male partners, unprotected anal intercourse with casual male partners, and the number of episodes of unprotected anal intercourse with casual male partners. Lastly, participants also showed an increase in condom use.

Prevention Strategy: Mpowerment

Description: This is a community-level prevention program for young, SGL men of diverse backgrounds that encourages the reduction of sexual risk, regular HIV testing, building positive social support among peers, and distribution of condoms and lubricants. The program includes peer-led sessions that are 3-hour meetings of 8-10 young, SGL men that focus on the need for frequent HIV testing, and safer sex behaviors. 

Evidence: A study evaluating the efficacy of the Mpowerment program among 298 participants when active in three community-based organizations from 2009 to 2012 showed improved behavioral outcomes at follow-up. These included increased HIV testing and self-efficacy for safer sex, and self-acceptance as young, SGL men. This study also showed that the program was associated with improved perceived positive social norms about safer sex and safer sex messages among gay/bisexual/transgender friends.

Prevention Strategy: Sister to Sister

Description: This is a 20-minute, one-on-one, HIV/STD risk-reduction behavioral intervention.  The intervention was delivered during the course of a routine medical visit for sexually active, 18 to 45-year-old African American women. The intervention provides culturally sensitive health information to empower and educate these women and help them understand behaviors that put them at increased risk. The goals of the program are to increase knowledge, motivation, confidence, and skills in making changes to behaviors that will reduce risk. 

Evidence: One study notes that women engaged in the Sister to Sister intervention in the northeast reported greater protected sexual intercourse and were less likely to test positive for an STD at a 12-month participation follow-up. 

Digital Health Coaching Provides Unique Benefits for HIV Prevention

The list above, while not exhaustive, shows programs that provide variety in populations and approaches in delivery. While these interventions are innovative, digital health coaching has a lot to offer in the HIV prevention space. Digital health coaching provides location-agnostic support for individuals and allows for consistency, personalized resources, and flexibility. This type of care and support can provide alternative or complementary support to existing HIV prevention programs. 

The strengths of digital health coaching in the HIV space are numerous. For one, Health Advisors are able to address co-existing social determinants and have the ability to care for people who might deal with issues related to poverty, racism, unemployment, and stigma. Additionally, communication via phone, email, or text provides a person who desires more education surrounding HIV a layer of anonymity. This allows them to ask questions and start conversations regarding sexual health or drug use that they might not feel comfortable asking in a face-to-face clinical setting. Digital health coaching can also be useful to those who have limited medical resources available to them due to existing barriers (e.g. those who live in a rural setting, those with limited transportation). 

Finally, the outstanding empathy and knowledge of Health Advisors add another layer of support to those seeking to prevent HIV. By paying close attention to broader issues that may influence decision-making, Health Advisors can work to reduce barriers for actions that would help prevent HIV risk behaviors. For example, Health Advisors can empower an individual with financial issues to obtain PrEP by helping them find a low or no-cost medication option.

With so many prevention options available, it certainly does not hurt to have another viable alternative. Digital health coaching can help expand the reach and serve the needs of those at risk for contracting HIV. Pack Health’s program is inclusive of all, no matter their age, gender, biological sex, race, ethnicity, sexual orientation, or socioeconomic status criteria; any person who is at risk for HIV can join the program. By providing more opportunities for HIV prevention, we can save lives, improve health outcomes, and collaboratively work to eliminate HIV.  

 

a person smiling for the camera

 

Tina Thomas, PhD
Senior Content Research Associate