Continuing with this theme, Kalichman et al. (2006) "examined the association between HIV treatment beliefs, HIV transmission risk perceptions, medication adherence, viral load and engaging in unprotected intercourse with any sex partners and specifically with sex partners who were not HIV positive (non-concordant)" (p. 401) among a convenience sample of 158 men and women living with HIV/AIDS and engaged in treatment. According to the investigators,
the pattern of associations ... suggests that beliefs that HIV treatments and having an undetectable viral load protect against HIV transmission were consistently and primarily related to increased likelihood of engaging in HIV transmission risk behaviors with non-concordant partners. These findings suggest that HIV transmission risk behavior may be disinhibited by beliefs that HIV treatments reduce HIV transmission regardless of one's own viral load and treatment adherence. ... [Moreover,] the context of a sex partner's HIV status is essential to consider when examining the associations of HIV treatment, adherence, and treatment beliefs in relation to sexual risk behaviors of people living with HIV/AIDS. (p. 408)
With regard to the transmission risk inherent in these beliefs, Kalichman and colleagues pointedly observe that
[a]lthough having an undetectable viral load likely does reduce the infectiousness of some people living with HIV, the … viral load in blood plasma may [be lower than the] … viral load in genital secretions. Factors such as adherence itself as well as individual variations in immune system functioning create considerable uncertainty about how viral load may be related to HIV transmission risks. Perhaps most critical are [STIs] and other sources of urethritis[,] which can cause significant viral shedding in the genital tract without affecting blood plasma viral load ... . Interventions for reducing HIV transmission risk among people living with HIV should at minimum inform individuals of what is known as well as what remains unknown about these complicated associations. (pp. 408-409)
Duru et al. (2006) examined potential correlates of sex without serostatus disclosure in a stratified random sample of 875 men and women within a nationally representative sample of 2,864 adults receiving HIV medical care in 1996. "Compared with marriage and/or primary same-sex ... [relationships], occasional partnerships and one-time encounters … were more likely to involve sex without disclosure. Knowledge of partner ... [serostatus] was also associated with sex without disclosure. Women were less likely to have sex without disclosure than men having sex with men" (p. 495). Importantly, the investigators identified
an association between a perceived responsibility to disclose to every partner and lower rates of sex without disclosure. ... The linking of disclosure and safer sex with a strong sense of individual responsibility may help inform the design of "prevention for positives" programs targeting those already infected. ... To the extent that prosocial motives, particularly perceived responsibility, are modifiable, identifying and including within such programs strategies to instill and nurture the ideas of responsibility to others might reduce rates of sex without disclosure of HIV-positive status. (p. 504)
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Winter 2007 Newsletter / Volume 8, Issue 2
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