Research article
Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people1

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Abstract

Background: As many as one in three HIV-positive people continue unprotected sexual practices after learning that they are HIV infected. This article reports the outcomes of a theory-based intervention to reduce risk of HIV transmission for people living with HIV infection.

Methods: Men (n=233) and women (n=99) living with HIV-AIDS were randomly assigned to receive either (1) a five-session group intervention focused on strategies for practicing safer sexual behavior, or (2) a five-session, contact-matched, health-maintenance support group (standard-of-care comparison). Participants were followed for 6 months post-intervention.

Results: The intervention to reduce risk of HIV transmission resulted in significantly less unprotected intercourse and greater condom use at follow-up. Transmission-risk behaviors with non-HIV-positive sexual partners and estimated HIV transmission rates over a 1-year horizon were also significantly lower for the behavioral risk-reduction intervention group.

Conclusions: This study is among the first to demonstrate successful HIV-transmission risk reduction resulting from a behavioral intervention tailored for HIV-positive men and women.

Introduction

Studies show that a significant minority of people living with HIV/AIDS continue to practice sexual behaviors that place their partners and themselves at-risk for HIV and other sexually transmitted infections (STIs).1, 2, 3, 4 Across a wide range of U.S. geographic areas, populations, and settings, the overall rate of continued unprotected intercourse is approximately 33% among people with HIV infection.5 Given the potentially grave consequences of continued unprotected sexual intercourse among HIV-positive people, there is an urgent need for prevention interventions designed for people living with HIV infection. Thus far, efforts to reduce HIV-transmission risk behavior have concentrated on strategies adapted from interventions for uninfected populations with disappointing results,6 and HIV antibody testing and counseling results in only modest behavior change in HIV-positive people.7, 8, 9 However, research does suggest that social support and mental health counseling interventions may have unanticipated positive effects on sexual transmission risk behaviors. For example, Coates et al.10 found that a stress management program for HIV-seropositive men in San Francisco surprisingly reduced numbers of sexual partners. Kelly et al.11 also reported reductions in sexual risk behaviors following three different mental health treatments.

In the current study, we tested a behavioral intervention designed to assist people living with HIV infection to reduce HIV-transmission risk behaviors. Our intervention model was grounded in Social Cognitive Theory,12 emphasizing the importance of building behavioral skills, enhancing self-efficacy for practicing risk-reduction behaviors, promoting intentions to change risk behaviors, and developing strategies for behavior change. We tailored our experimental intervention for HIV-positive people and framed the intervention content within the context of managing stress related to HIV disclosure and practicing safer sexual behavior. Because there is evidence that social support groups can affect risk behavior, we used a social support group model as a standard-of-care comparison intervention in a randomized effectiveness trial design. We hypothesized that the behavioral risk-reduction intervention would demonstrate less sexual risk behavior, particularly risks posed to HIV-negative sexual partners, compared to the social support group condition.

Section snippets

Recruitment and randomization

Men and women were recruited from AIDS services and infectious disease clinics in Atlanta, Georgia. Flyers announcing the study opportunity were posted in these locations, and providers were asked to refer clients to the study. To increase the external validity of the study, the only eligibility criteria for participation were: (1) living with HIV/AIDS, and (2) voluntary willingness to complete the study activities. Participants were informed that their HIV status would be verified by

Social cognitive theory constructs

Results of MANCOVA testing for intervention effects on risk-reduction self-efficacy indicated significant differences between conditions (Wilks’ lambda=0.95, F [5, 242]=2.57, p<0.05); risk-reduction intervention participants reported greater self-efficacy for suggesting condom use with new sexual partners and being able to satisfy sexual partners and oneself by practicing safer sexual behavior (see Table 2). Similar results occurred for the MANCOVA analyzing risk-reduction intentions (Wilks’

Discussion

This study is among the first to demonstrate positive effects of a theory-based behavioral intervention designed to reduce HIV sexual-transmission risks among men and women living with HIV infection. The risk-reduction intervention resulted in lower rates of anal and vaginal intercourse across all sexual partners, and reduced potential exposures of HIV to sexual partners with unknown and known HIV-negative statuses relative to a standard-of-care comparison intervention. In addition, modeling

Acknowledgements

Intervention manuals are available upon request. We are grateful to the staff of AIDS Survival Project and Positive Impact Inc. of Atlanta for their assistance. This research was supported by National Institute of Mental Health (NIMH) grant R01-MH57624.

References (28)

  • G. Marks et al.

    Reducing sexual transmission of HIV from those who know they are infectedthe need for personal and collective responsibility

    AIDS

    (1999)
  • A.G. Robins et al.

    Psychosocial factors associated with risky sexual behavior among HIV-seropositive gay men

    AIDS Ed Prev

    (1994)
  • P.D. Cleary et al.

    Behavior changes after notification of HIV infection

    Am J Pub Health

    (1991)
  • C. Hankins et al.

    Sexuality in Montreal women living with HIV

    AIDS Care

    (1997)
  • S.C. Kalichman

    HIV transmission risk behaviors of men and women living with HIV-AIDSprevalence, predictors, and emerging clinical interventions

    Clin Psychol Res Pract

    (2000)
  • P.D. Cleary et al.

    A randomized trial of an education and support program for HIV-infected individuals

    AIDS

    (1995)
  • W. Darrow et al.

    Impact of HIV counseling and testing on HIV-infected men who have sex with menthe South Beach Health Survey

    AIDS Behav

    (1998)
  • L. Weinhardt et al.

    Effects of HIV counseling and testing on sexual risk behaviormeta-analytic review of published research, 1985–1997

    Am J Pub Health

    (1999)
  • C. De Rosa et al.

    Preventive counseling of HIV-positive men and self-disclosure of serostatus to sex partnersnew opportunities for prevention

    Health Psychol

    (1998)
  • T. Coates et al.

    Stress reduction training changed number of sexual partners but not immune function in men with HIV

    Am J Public Health

    (1989)
  • J. Kelly et al.

    Outcome of cognitive-behavioral and support group brief therapies for depressed persons diagnosed with HIV infection

    Am J Psychiatry

    (1993)
  • A. Bandura

    Self-efficacythe exercise of control

    (1997)
  • M. Nebot et al.

    AIDS and behavioural risk factors in women in inner city Baltimorea comparison of telephone and face-to-face surveys

    J Epidemiol Community Health

    (1994)
  • S.C. Kalichman et al.

    Validity of self-reported CD4 lymphocyte count and viral load test results in people living with HIV-AIDS

    Int J STD AIDS

    (2000)
  • Cited by (0)

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