October 27, 2001
Efforts to prevent transmission of HIV have focused a lot on educating the general public about the risks of HIV transmission: the modes, the behaviors, the specific practices associated with HIV transmission, and the promotion of the use of condoms and "safer" sexual practices.
The educational focus has not targeted -- at least not with the same intensity -- already infected HIV-positive individuals because it was perceived as "politically incorrect" and something that would contribute to the stigmatization of this population. However, it is obvious that efforts to prevent transmission should involve both the general public and the HIV-infected population. The sexual partners of HIV-infected individuals are a population at high risk for HIV acquisition. Any efforts to prevent transmission within that specific population will have a much quicker payoff than anything we may do within the general public. Thus it is necessary for HIV-positive patients to be educated about the risk of transmitting HIV and how to prevent transmission to others. Part of these efforts involves disclosure to sexual partners.
In spite of all this, many HIV-infected individuals do not notify their partners about their HIV status, and a significant proportion of them continue to engage in high risk behaviors. Why and how often does this happen? The reasons are complicated, not very well understood and beyond the scope of this short commentary. O'Brien, who led the research at Tulane University School of Public Health and Tropical Medicine, tried to tackle the second of these questions: how often does this happen?
The numbers are sobering: approximately half of all interviewed patients (around 200 of them) did not notify their partners. And half of the "knowing" seronegative partners continue to have unprotected sex. The only good news was that the people who notified their partners about their HIV status were more likely to use condoms during their last sexual relationship.
It is obvious that a strong effort should be made to educate patients about the importance of disclosure and preventive measures to reduce the transmission of HIV. This will involve reducing the stigma still associated with this disease, and fighting complacency and the idea that HIV infection is not as terrible as it used to be. Current complacency has led to increased rates of infections in San Francisco, and San Francisco has always been a harbinger of what is going to happen in the near future in the U.S.