mental health AIDS

Fall 2004 Newsletter / Volume 6, Issue 1

HIV Prevention News

Crepaz, Hart, and Marks (2004) conducted three meta-analyses of English-language studies published between January 1996 to August 2003, along with other information sources from the same period, to determine if 1) being treated with HAART (21 findings), 2) having an undetectable viral load (13 findings), or 3) holding specific beliefs about HAART and viral load (18 findings) are associated with increases in the likelihood of having unprotected sex. They found that

the prevalence of unprotected sexual intercourse was not significantly higher in the group of HIV-positive persons receive HAART (vs not receiving HAART) or in the group of HIV-positive persons with undetectable (vs detectable) viral load. Unprotected sex was, however, associated with people's beliefs about HAART and viral load. Regardless of their HIV serostatus, the likelihood of unprotected sex was higher in people who agreed that receiving HAART or having an undetectable viral load protects against transmitting HIV or that the availability of HAART reduces their concerns about having unsafe sex. (p. 234)

The authors urge that

HIV and [STD] patients should receive prevention messages emphasizing that having an undetectable viral load does not eliminate the possibility of transmitting HIV nor does it mean that an infected person is"cured" of the virus. Even HIV-positive patients who are engaging in safer sex should hear these messages to reinforce their safer-sex practices. Similar messages are also needed for a broader audience because beliefs about HAART and viral load held by those who are HIV-negative and whose serostatus is unknown were significantly associated with their sexual risk behaviors. (p. 235)

Regarding prevention counseling, Bolu et al. (2004) conducted a subset analysis of data from Project RESPECT, a multisite RCT that compared the capacity of three clinic-based interventions to increase condom use and prevent HIV/STD infection. A total of 4,328 men and women were randomized to one of the three interventions (HIV education [the control condition], brief prevention counseling, or enhanced prevention counseling) and followed for 12 months. After 12 months, participants receiving either form of interactive, risk-reduction counseling had fewer STDs than participants receiving educational messages. The authors conclude that" HIV/STD prevention counseling (brief or enhanced counseling) resulted in fewer STDs than educational messages for all subgroups of STD clinic clients, including high-risk groups such as adolescents and persons with STDs at enrollment" (p. 469).

Finally, what is the potential for HIV transmission to partners of those already infected and engaging in high-risk behavior? Weinhardt et al. (2004) interviewed an ethnically- and geographically-diverse convenience sample of 3723 people living with HIV in four U.S. cities – 1918 MSM, 978 women, and 827 heterosexual men. Less than 25% of the latter two groups recalled two or more sexual partners during the three-month reporting period, while multiple partners were recalled by 59% of the MSM studied. Although most acts of unprotected intercourse (vaginal or anal) were reported to have occurred with seroconcordant partners, unprotected sex with a known or possibly serodiscordant partner was reported by about 13% of heterosexual men, 16% of MSM, and 19% of women, even as the majority indicated that they had disclosed their serostatus to all unprotected partners. It also bears noting that, of the 304 individuals who injected drugs during the three-month reporting period, 18% shared their injection equipment with others. Weinhardt and colleagues estimated that 30.4 new infections (79.9% of these in the context of sexual activity with MSM) could be expected to have occurred among sex partners of those participating in this study during the three-month reporting period. They conclude that"[b]y integrating prevention with medical and social care services, it will be possible for persons with HIV infection to live longer and healthier lives and to avoid behaviors that could result in virus transmission to others and their own exposure to additional [STDs] and treatment-resistant strains of HIV" (p. 1065).

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