HIV/AIDS prevention programmes in Africa are failing to include people living with the virus, despite the fact they are vulnerable to reinfection and could, unless properly informed, transmit the virus to others.
"We know that sex goes on between HIV-discordant people [one person is HIV-positive and the other not], and between HIV-positive people, but few studies have been done on behaviour risk reduction among HIV-positive people," said Leickness Simbayi, southern Africa regional director for the research group, the Social Aspects of HIV/AIDS and Health Research Alliance (SAHARA).
Most African governments have launched large-scale HIV prevention campaigns that target the youth and other vulnerable groups, but the programmes have not explicitly taken into account the estimated 25 million people already living with the virus.
Speaking at a SAHARA conference this week in Kenya's western city of Kisumu, Simbayi said stigma, denial, exclusion and discrimination against those living with HIV and AIDS led people to hide their status and potentially keep engaging in risky sexual behaviour.
Simbayi said the current focus on antiretroviral (ARV) treatment had blunted prevention programmes. "The emphasis on treatment has left prevention as a secondary concern," he commented. "There is also some evidence that ARVs increase risky behaviour among HIV-positive people due to treatment optimism."
The key to encouraging prevention among HIV-positive people lay in getting more people into voluntary counselling and testing centres, Simbayi said. Despite information blitzes across the continent over the past decade-and-a-half, most Africans still did not know their HIV status.
According to a 2005 national survey by South Africa's Human Sciences Research Council, just 20 percent of the 5.4 million South Africans thought to be HIV-positive knew they were infected.
"All African citizens must have access to testing facilities so they can be part of 'positive prevention'," said Richard Muga, of Great Lakes University of Kenya, in Kisumu. "Even after becoming HIV-positive, sexual life does not stop."
Simbayi said two "positive prevention" models were being tested for efficacy in Africa. One, based on social support groups of men and women living with HIV, was designed to combat fear and encourage disclosure; the other, a clinic-based method, used motivational techniques, such as seeing someone disclose their status without negative consequences, to promote behaviour change.
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