Routine Brief Risk-Reduction Counseling With Biannual STD Testing Reduces STD Incidence Among HIV-Infected Men Who Have Sex With Men in Care

The researchers evaluated whether routine, twice-yearly STD testing, together with brief risk-reduction counseling, reduces STD incidence and high-risk behaviors.

The SUN study is a prospective, observational HIV cohort study carried out in four US cities. At enrollment, then at six-month intervals, participants completed a behavioral survey and underwent STD testing. If diagnosed, they were treated. All participants received brief risk-reduction counseling from medical providers.

Among men who have sex with men (MSM), the researchers examined STD incidence trends and rates of self-reported risk behaviors before and after exposure to the risk-reduction counseling. The pre-intervention visit was the study visit that took place at least six months after enrollment STD screening and treatment, and at which the participant was first exposed to the intervention; the post-intervention visit occurred 12 months later.

Complete STD and behavioral data were available for 216 MSM. The men's median age was 44.5; 77 percent were non-Hispanic white; 83 percent were taking highly active antiretroviral therapy; 84 percent had an HIV RNA level <400 copies/mL, and their median CD4 count was 511 cells/mm3. Twelve months after they were first exposed to the risk-reduction intervention, STD incidence among the men declined from 8.8 percent to 4.2 percent (P=0.041). Rates of unprotected anal intercourse (insertive or receptive) with HIV-positive partners increased from 19 percent to 25 percent (P=.024); they did not change with partners who were HIV-negative or of unknown serostatus (24 percent to 22 percent, P=0.590).

"STD incidence declined significantly among HIV-infected MSM after implementing frequent, routine STD testing coupled with risk-reduction counseling," the authors concluded. "These findings support adoption of routine STD screening and risk-reduction counseling for HIV-infected MSM."

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