Effectiveness of an Intervention to Reduce HIV Transmission Risks In HIV-Positive People

Studies show that a significant minority of people living with HIV/AIDS continue to practice sexual behaviors that place their partners at risk for HIV and other STDs and further complicate their own physical health. The overall rate of continued unprotected intercourse across a range of US geographic areas, populations and settings is approximately 33 percent among people with HIV infection. Efforts to reduce HIV-transmission risk behavior have focused upon interventions for uninfected populations and have had disappointing results. HIV antibody testing and counseling have also resulted in only modest behavior change. Research does suggest, however, that social support and mental health interventions may have positive effects on sexual transmission risk behaviors. This study tested a behavioral intervention designed to assist people living with HIV infection to reduce HIV-transmission risk behaviors.

Men (n=233) and women (n=99) living with HIV/AIDS were randomly assigned to one of two groups. One group featured a five-session intervention based on strategies for practicing safer sexual behavior. The other group featured a five-session, contact-matched health maintenance support group. All participants were followed for six months, post-intervention. Participants were 74 percent African-American, 22 percent white and 4 percent of other ethnicities. About one half of the participants had completed 12 years of education, and 55 percent had incomes less than $10,000 annually. Fifty-three percent currently received disability benefits. Through self-administered surveys and detailed structured interviews that focused upon sexual risk and protective behaviors, participants completed measures at baseline, immediate post-intervention and at three and six months following the intervention. Two group facilitators, including an HIV-positive peer counselor, led the intervention sessions. Fifty-two percent of participants were homosexual, 39 percent were heterosexual and 9 percent were bisexual.

Individuals in the intervention groups were offered lessons on coping with HIV-related stress and risky sexual situations; improving participant's ability to decide how to reveal HIV status to sexual partners; and promoting safer sex practices. Individuals in the control group attended five meetings of social support.

Six months after the end of the study, participants in the intervention group were less sexually active, less likely to engage in unprotected sex and more likely to use a condom. Estimated HIV transmission rates over a one-year period were significantly lower for the intervention group.

According to the authors, 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." The authors emphasized that in the face of a growing population of people living with HIV/AIDS, "the potential for transmitting HIV treatment-resistant virus, and the absence of a preventive vaccine, increasing access to theory-based, behavioral risk-reduction interventions offers our greatest hope for preventing HIV infections."

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