Special Coverage: 12th Conference on Retroviruses and Opportunistic Infections
Even after diagnosis, risky behaviors persist
Protection used more often with strangers
An HIV diagnosis lowers risky sexual behavior, but not by as much as public health officials might hope, new research suggests.
Investigators studied self-reported sexual behavior of 152 men who have sex with men (MSM) in Southern California who recently acquired HIV to see whether their risk behaviors significantly changed three months after they received their HIV diagnosis.
The men participating in the study reported less risky sexual behavior at a three-month post-diagnosis interview than at their interview just after their diagnosis, yet many risk behaviors persisted.1
"We saw a little bit of behavior change, but not a lot," says Pamina M. Gorbach, MHS, DrPH, an assistant professor in the department of epidemiology in the School of Public Health and division of infectious disease in the School of Medicine at UCLA.
"There’s still quite a lot of men who continue to have a lot of partners," she explains. "And there was no difference in the percentage who reported unprotected anal intercourse with their last partner."
At baseline, 59% of MSM reported having had unprotected anal intercourse with their last sexual partner, and at the follow-up interview, the percentage was the same.1
These unprotected encounters frequently occurred with their main partners, Gorbach adds.
The number of partners reported by the sexually active MSM dropped from a mean of nearly eight at baseline to a mean of 5.2 at follow-up.1
Researchers inquired about unprotected sex with various types of partners, including main partners, unknown partners, one-time partners, and acquaintances or regulars other than the main partner.
"They were less likely to have unprotected anal intercourse with an unknown or one-time partner," Gorbach says. "Most of them did use condoms, and we saw that percent go up between baseline and follow-up, and that was good news."
Just after their diagnosis, 65% of MSM reported having used condoms with their last one-time partner, and 38% of MSM reported using condoms with their last unknown partner, she notes.
Also with unknown partners, fewer MSM reported having unprotected anal intercourse at follow-up than at baseline, Gorbach says.
However, with their main partners, three months post-diagnosis only 22% of MSM reported using condoms the last time they had anal intercourse, she adds.
"One of the big findings from this study is people are more likely to report unprotected intercourse with their main partner than with any other partner," Gorbach notes. "And at the follow-up, they were more likely to take the risk if they knew their partner also was positive."
The men were modifying their risk, but not eliminating it, she says.
"Of course, in the public health arena, we think it’s good HIV-infected MSM are more likely to follow safe behaviors with HIV-negative partners than with HIV-positive partners, thus reducing transmission to uninfected people," Gorbach says.
"But some researchers are concerned about superinfection, and if HIV-positive people are continually exposing themselves to other people’s viruses, then they might be infected with another strain," she says. "The issue of superinfection is controversial, and there’s debate in the literature about whether it’s a concern; but if it’s a concern, we have to worry about it."
The research into behavioral changes following HIV diagnosis is part of the research into what happens during acute and early HIV infection, conducted as part of the Acute Infection and Early Disease Research Program (AIEDRP) consortium by the National Institutes of Allergies and Infectious Diseases (NIAID), Gorbach says.
"We started three years ago to look at sexual behavior and risks coming from sexual partnerships from people identified with acute and early HIV disease, who were enrolled in clinics through AIEDRP in Southern California," Gorbach says. "We did a year of pilot work to develop a good questionnaire, and then we started to do this behavioral interview with every man and woman identified in the program, every time they came in for the clinical study."
Participants, who were found to have been infected within the previous 12 months, underwent intensive testing in their first few visits in the study after being told they had HIV, Gorbach explains.
By the third visit, within a month after diagnosis, they take the baseline questionnaire about their behavior. A shortened version of the questionnaire is administered when the patients are seen at three month clinical visits, Gorbach says.
The questionnaire was administered via a laptop computer, and their answers were identified by a number and not a name, she says.
"It was designed to be useful for low literacy patients, as well," Gorbach notes. "We ask about the types of partnerships they’re involved in and the dynamics of those partnerships."
The study’s findings suggest that prevention for positives should be tailored according to the different kinds of partners MSM have, she says.
"In this study, we look at who the partners are and which ones are at risk," Gorbach says.
"While many of these men have unknown partners, they did reduce those risk behaviors quite a bit and used condoms more with those partners," she says. "But I’m worried about people who have formed a main partnership, and if not using condoms is an expression of intimacy, they tend to not use condoms with that main partner."
So HIV-infected MSM will bring infection into their main partnership, where it’s difficult for them to start using condoms, Gorbach explains. "That’s a problem for people who are HIV-positive, as much as for those who aren’t. They need special help in managing HIV within a partnership to protect that partner from getting infected."
The men are better at protecting the people they don’t know than the people they’re closest with, Gorbach notes.
"So when we’re counseling people with HIV for the Prevention for Positives campaign, we need different messages for the different partners people have," she adds. "One strategy and one approach won’t work across all sexual partnerships, as people’s behavior varies according to their partnership type."
Reference
- Gorbach PM, Drumright L, Daar E, et al. Transmission Behavior following HIV diagnosis. Abstract presented at the 12th Conference on Retroviruses and Opportunistic Infections, Boston; February 2005. Abstract 981.
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