HIV transmission: guidelines for assessing risk - Canadian AIDS ...

HIV TRANSMISSION: Guidelines for Assessing RiskForeward and AcknowledgementsThe 5th edition of HIV Transmission: Guidelines for AssessingRisk marks a significant step forward in the evolution of theCanadian AIDS Society’s guidelines. For the first time, therevised guidelines incorporate hepatitis C (HCV) informationand a section on assessing the risk of HCV infection. Italso contains information included in the last edition, suchas that on injection drug use and maternal transmission.As well, this edition retains the range of biological factors,including mucosal immunity, and HIV viral load, highlightingthe complex factors that may increase or reduce anindividual’s risk of infection.HIV and HCV transmission do not occur in a biologicalvacuum. Research over the past few years has demonstrateda complex interplay among biological, sociological,psychological and economic factors that influences thevulnerability of individuals and specific groups of individualsto viral transmission. It has become clearer and clearerthat issues of class, power and socioeconomic status aremajor determinants of susceptibility to HIV infection. Themodel of attributing risk of HIV transmission to variousactivities has been retained, but an introductory section hasbeen included to place the scientific information presentedin later sections in context. Educators and health careproviders must realize that to prevent HIV transmissionsuccessfully they must incorporate prevention informationwithin the reality of an individual’s life. Using a condommay not be possible for everyone, for a variety of complexreasons. Similarly, abstaining from taking drugs or using anew and/or unshared needle and syringe every time a drugis injected may not be possible for everyone. All educatorsand health care providers should work towards developingstrategies that can help reduce an individual’s risk of HIVinfection, even if that risk is not eliminated. This may mean,for example, that assisting an individual to find stable housingmay be more effective at preventing transmission thanproviding the individual with a box of condoms.We hope that these guidelines offer a framework fromwhich to work with individuals from diverse communitiesand life experiences. These guidelines are by no means thefinal word. As information and circumstances change, so toowill the guidelines. The HIV and HCV epidemics are farfrom over. In fact, they are constantly growing and shifting.Treatment advances are enabling many people with HIV tolive longer and healthier than in the past. However, we area long way from a cure, for either HIV or HCV and thereare no vaccines in sight to prevent further infections. HIVand HCV prevention and education remains our strongestweapon in the fight against these diseases.In contrast to previous editions, these guidelines incorporatetransmission information and assessment of risk for HCV,a major concern for those people doing HIV work in thecommunity. HCV infection in Canada is rapidly on therise, especially among injection drug users, and many inpublic health and the medical community consider it tobe an epidemic on a grand scale. As a result, informationhas been included here about HCV and assessing its risk,acknowledging the many AIDS Service Organizations andfront-line workers who have taken on the role of deliveringHCV transmission information in the absence of an officialstrategy from Health Canada on coping with this secondepidemic.The Canadian AIDS Society continues to acknowledge theassistance of the organizations and individuals who contributedto the first, second and third editions of this documentin 1988, 1994 and 1999, respectively.We wish to express our gratitude to those who assisted usin developing the framework for this fourth edition. Inparticular, we are grateful for the time, energy and enthusiasmof the Review Committee, comprised of Daryn Bond,Claire Checkland, Darren Greer, Marc-André LeBlanc,Michael Mancinelli, Roger Procyk, Maxxine Rattner,Shaleena Theophilus, Kim Thomas, Sarah Tsiang, LynneBelle-Isle, Stéphanie Laporte, Christian Joubert, MichelMorin, Dominic Lévesque, Linda Truglia, Jean Dussaultand Jeremy Ries. The Canadian AIDS Society would alsolike to thank all those who worked on previous editions ofthe guidelines, including Health Hounds, and the consultantsand writers. This edition contains much that has gonebefore and could not have been completed without theircontributions.3