CDC’s New Risk Reduction Tool; Understanding HIV Risk Factors and Exploring Prevention Options
David W. Purcell, JD, PhD, Deputy Director
Behavioral and Social Science
Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, Sexual Transmitted Diseases and
Tuberculosis Prevention (NCHHSTP), CDC
Today is an exciting and challenging time for HIV prevention. For many years, our primary prevention option for sexual risk reduction was condoms, which remains a very effective option. But happily, we now have biomedical options such as medicines to treat HIV (antiretroviral therapy), which improves the health of people living with HIV and dramatically decreases the chance of transmitting HIV to partners. For HIV-negative persons, both pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) reduce the chance of acquiring HIV. Other prevention tools include behavioral options such as choosing particular behaviors or partners to reduce risk.
It is important to communicate clearly about these options and how well they work. In light of new science, and input from community partners, in 2013 CDC re-examined its prevention messages and stopped using the terms "protected" or "unprotected" sex. Instead, CDC uses more precise language in prevention messages including on the web, in research, and in communication campaigns. An example of integrated prevention messages comes from the Act Against AIDS campaign for gay and bisexual men that CDC launched in 2014, called "Start Talking. Stop HIV.” The campaign slogan reads "Protect yourself and your partner. Talk about testing, your status, condoms, and new options like medicines that prevent or treat HIV." These messages have been incorporated into CDC’s content across its website.
In December 2015, at the National HIV Prevention Conference in Atlanta, CDC introduced the beta or pilot version of its’ new HIV Risk Reduction Tool. This tool provides the first comprehensive update of CDC's HIV prevention messages for all audiences. The tool was developed through a systematic scientific process and includes two separate parts – comprehensive messages and an interactive "know the HIV risk" estimator. Key design features include; 1) messages on a range of topics that are filtered based on tailoring variables, 2) content that can be personalized by gender, HIV status, and gender of sex partner, 3) critical information with options to go into greater depth and seek additional resources and, 4) an interactive tool that allows users to select various behaviors and to visualize HIV risk associated with those behaviors and how risk changes as users choose various risk factors (STDs and acute HIV infection) or prevention options (ART, PrEP, condoms, serosorting and circumcision). CDC recently released numeric tables to support the HIV Risk Reduction Tool, including tables on per-act transmission numbers for a variety of behaviors and the effectiveness of various prevention options to reduce risk and factors that increase risk. The tables include an explanation for each number that has been chosen by CDC from the scientific literature. These numbers will be updated as the science evolves.
The Beta version of the HIV Risk Reduction Tool will be improved and updated through usability testing, formal evaluation of users, and engaging external and internal stakeholders. The tool is available online at www.cdc.gov/hivrisk and users are encouraged to try the tool and send feedback through the button available on every page. We look forward to your hearing from you!