News & Events

Behaviors Change After HIV Testing
Posted to the Web: Wednesday, December 05 , 2007
December 5, 2007 (Atlanta) — The amount of data available on the effect of HIV testing on behavior is large and continues to grow, but a common finding appears to be the continued practice of riskier sexual acts. Presentations made here at the 2007 National HIV Prevention Conference offered some subtle nuances to that picture.

Nicole Crepaz, PhD, from the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, provided the first qualitative meta-analysis of literature in the field of HIV-positive men who have sex with men (MSM) who know their HIV status. The study focused on 27 studies with a total of 10,100 participants that excluded the outlier populations of sex workers and persons sharing the risk factors of MSM/injecting drug users. In 15 of the studies, the majority of the participants were white, whereas blacks or Hispanics constituted a majority in the other 12 studies.

The overall prevalence of unprotected anal intercourse (UAI) was 35.4%. Dr. Crepaz saw no statistically significant differences by race or ethnicity. One striking feature was that MSM recruited on the Internet reported significantly higher rates of UAI (66.3%).

Seven studies (n = 3975) asked participants about behavior according to the partner's serostatus. The researchers found that 30.6% of respondents engaged in UAI with other persons whom they knew to be HIV-positive, but that number dropped to 14.9% when the partner's serostatus was unknown and to 9.8% when the partner was known to be HIV-negative.

"This suggests that serosorting is going on," said Dr. Crepaz. However, it increases the risk of HIV-positive persons acquiring another sexually transmitted disease. She noted that prevention messages should be "not only [to] protect others but [to] protect one's own health."

Kenneth Mayer, MD, from Fenway Community Health, Boston, Massachusetts, and Brown University/Miriam Hospital, Providence, Rhode Island, offered further evidence to the continued occurrence of risky behavior and suggested serosorting among 398 men participating in a study at Fenway Community Health. The study was conducted as a baseline for future interventions.

Participants primarily were long-term patients of the clinic, had been HIV-positive for 8.6 years, and were on average 41.5 years of age (range, 20 – 68 years). About two thirds of the patients were receiving antiretroviral therapy, and more than half had undetectable viral loads. About 75% were white, as is the client base of the clinic. The age groups had similar characteristics.

"There was an 18% incidence of sexually transmitted infections, primarily syphilis" within the previous 6 months, Dr. Mayer said. The 30- to 39-year age group was significantly more likely to have had a sexually transmitted infection. He added that there is some evidence to support serosorting when it came to UAI.

High use of alcohol and nonprescription drug use also was reported by the cohort. "Crystal methamphetamine use in the prior 3 months was reported by 22.9% [of the participants]." Younger age and being in care for a shorter period of time also were predictive of risky behavior, but "being on antiretroviral therapy was not predictive either way."

Dr. Mayer believes these data indicate the need to tailor interventions to the individual and to couple sexual risk reduction counseling with substance abuse counseling.

Manya Magnus, PhD, a researcher at George Washington University, Washington, DC, has been working on a CDC-sponsored cross-sectional study in Washington, DC. The city has the highest HIV prevalence rate in the nation (128.4/100,000 citizens vs the rest of the United States at 14/100,000). Dr. Magnus' field study focused on heterosexuals.

She was concerned that testing negative might create a "get a free ride card" attitude and result in increased sexual risk taking among this low-income (~75% earned <$20,000 annually), African-American (95%) sample. But the self-reported survey of 798 persons found "no significant negative consequences of testing on behavior."

Dr. Crepaz, Dr. Mayer, and Dr. Magnus have disclosed no relevant financial relationships.

2007 National HIV Prevention Conference: Abstracts B04-1, B04-4, B01-3. Presented December 4, 2007.