Prevention: An Overview of Preventing HIV, STDs and Chronic Diseases

James Curran, M.D., MPH

Good health begins with people understanding the importance of prevention and lifestyle. In order to advocate for prevention in their communities, schools and cities, it is important for individuals to know how to keep themselves and others healthy through adequate diet and physical activity, by avoiding smoking, by drinking only in moderation, and by getting regular medical checkups.

The idea that avoiding and preventing disease is a lot better than suffering with disease usually resonates well with the general public. However, prevention must connect behaviors now with what may be avoided later, and often needs to occur in the absence of illness or any similar motivation. For example, smoking may cause a flare up of asthma for some people now, but it leads to long-term problems with heart disease, cancer and lung disease in numerous people later. Prevention efforts need to be directed to not smoking in the first place or to stopping smoking well before any illness. Prevention is about encouraging individuals to lead healthy lifestyles, to avoid drugs and excessive use of alcohol, to engage in physical activity and to maintain good diets.

Understanding how large-scale environmental and global factors can support prevention also help us to avoid disease later on. These factors are largely outside of peoples’ individual control, yet are the easiest areas in which to raise public awareness and concern. We all generally understand that air pollution is a cause of illness and that we should try to reduce air pollution. It’s easy for us to understand that violence in society should be stopped to avoid injuries, that we should have safer automobiles, that we should have good labeling and protection on medicines and other products to protect children and other people.

In terms of global HIV prevention, 2 million people across the world became infected with HIV last year. That is lower than the 3 million people infected per year 10 years ago and represents a substantial reduction in transmission, but it is still a very large number of people. We know that if resources are available and applied toward good testing, counseling, diagnosis of HIV, access to and provision of care and antiviral medications, we can reduce transmission to others. With current medications, chronic disease management of HIV also has the benefit of reducing transmission of HIV to others. This is how we link HIV care and HIV prevention.

This global HIV prevention strategy has been extended to roughly 30-40% of the people in the world, but it needs to be expanded to the other 60-70%. HIV infection is a chronic disease because it is a lifelong infection with lifelong consequences. People need to be diagnosed early, begin treatment with antiviral drugs early, and stay on them for life. In the United States, the majority of people who are HIV-positive have already been diagnosed and the HIV transmission rate has declined over the last 15 years to somewhere around 40,000 or so per year. The HIV prevention strategies that we have used share common threads with broader STD prevention and connect directly to reproductive health.

Prevention of STDs requires consistent condom use with new partners, diagnostic testing, and early diagnosis and treatment. Preventing both HIV and STD involves an understanding of broader reproductive health and sexual health. Unintended pregnancy has major health consequences, and ensuring good preventive reproductive health requires education, access to contraceptive services and access to other reproductive health services. The rate of unintended pregnancy is lower now in the U.S. than it has been in many years, but is still the highest among all industrialized countries. In general, people should understand how to safely have sex - to avoid unintended pregnancy and avoid STDs - which involves contraceptives and condoms or avoidance of sexual activity outside of a tested monogamous partnership.

There are lessons from HIV prevention that we can apply to prevention of other chronic diseases. One thing that we’ve learned from HIV prevention is that it is very important to link care with prevention. In order to have a program for prevention, you also need to have a program for treatment. We can’t have a situation where people don’t have access to care for lung disease, heart disease, or diabetes, and then say that all you really need to do is exercise and maintain a good diet. We need instead to focus on the importance of the clinical aspects of diabetes which then informs prevention efforts, and also highlights the importance of the problem which motivates people not to become affected.

In closing, my advice to the public is this: Exercise, eat a good diet, don’t drink in excess, think about your sexual health in terms of STDs and unintended pregnancy, and also think about your mental health. An ounce of prevention really is worth a pound of cure.

James Curran, M.D., MPH, is a Professor of Epidemiology and Dean of the Rollins School of Public Health at Emory University.

This blog post is part of a series focusing on different aspects of public health in recognition of Public Health Thank You Day, held each year othe Monday before Thanksgiving. Visit www.publichealththankyouday.org for more information, and join us on social media using the hashtag #PHTYD.

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