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Question #1: Are those who pass on infection reckless? Question #2: Do responsible people take steps to protect themselves?
Sep 10, 1997

What evidence is there of behavior change among those who find out they have HIV?

My next question would be: how do you know most people with HIV are responsible? Could they really be responsible if they got the disease from someone else? Wouldn't a responsible person have taken steps to protect themselves?

Response from Mr. Sowadsky

Thank you for your questions. People who are HIV positive do not know it, until they are tested. Until they get tested, they may unknowingly transmit the virus to others. Many people who are infected (but have not yet been tested) do not perceive themselves to be at risk. Sometimes this is due to denial, or sometimes, simply a lack of education on the subject. For example, many heterosexuals still think of AIDS as an exclusively Gay/IV drug users disease, and often do not protect themselves against HIV. If a person does not perceive themselves to be at risk, they are less likely to take steps to protect themselves (and others). If a person is in denial about their personal risk, they are also less likely to protect themselves. In addition, some young Gay men, look at HIV as something they are ultimately going to get anyway, so they are less likely to protect themselves; sadly, some young Gay men have a very fatalistic attitude towards HIV and AIDS.

If a person is aware that they are infected, they are much more likely to take steps to protect others from the virus. In addition, using protection can also have health benefits for the person who is already positive themselves. See the posting "possible cross-infection btwn HIV+ couple" for more information on this.

There have indeed been many research studies over the years that have shown that once a person knows they have HIV, they are more likely to use condoms, and less likely to share needles with other people. This is not surprising, since the reality of a persons risk for HIV becomes more real, once they find out that they are infected.

Of course, using condoms does not come automatically. Not everyone with HIV feels comfortable using condoms. Condom use tends to be more common in discordant couples (where one partner is known to be positive, and the other is known to be negative). However, there are sometimes barriers to condom use. These may include substance abuse problems (condoms tend to be used less often or incorrectly if a person is drunk or high on drugs). In addition, not using condoms can also be due to a feeling that condoms interfere with sexual enjoyment. There are other psychological issues that can sometimes lead to a decrease in condom use in persons known to be positive. The posting, "Studies of Gay Discordant Couples" covers some of these issues.

Multiple research studies have already shown that persons with HIV are indeed more likely to protect others against infection. However ongoing safer sex counseling, and other similar types of continuous intervention, are important to prevent relapse to unsafe practices. This is often done in a number of ways, especially in support groups for persons with HIV. Such support groups can be found in many local communities, and even through online services, such as America Online (AOL).

In summary, persons who are infected with HIV, but do not yet know that they have the virus, often do not perceive themselves at risk. Once a person finds out that they are positive, they are much more likely to take steps to protect others from the infection. However, because there are many barriers to using protection every time a person has sex or shares needles, continued interventions are necessary to prevent relapse to risky activities. Human behavior is a very complicated subject, and condom use in persons who are HIV positive does vary from person to person. However, research studies have already shown that the majority of persons who know they have the virus, are much more likely to take preventative measures, than persons who have not yet been tested, or are not aware that they are at risk. For more information on a related topic, see the post, "Reckless Endangerment"

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).



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