HIV Prevention: "Survival Sex" and Substance Abuse May Hinder HIV Prevention Efforts

Interviews with 256 people attending a New York City HIV clinic revealed that 41 percent engaged in unprotected sex after learning they were HIV-positive. Lead author Dr. Joseph P. McGowan of the Bronx-Lebanon Hospital Center in New York said HIV-positive women may be more likely to have unprotected sex due to trading sex for drugs or money, or a "lack of empowerment or low self-esteem. For example, does the woman have the ability to say no if the man doesn't use a condom?" The study reported that highly active antiretroviral therapy (HAART) patients were more likely to have unprotected sex, perhaps believing that HAART decreased their chances of transmitting HIV. In fact, HAART may reduce the risk of HIV transmission, but it does not eliminate it, and patients could pass on a drug-resistant strain of the virus.

McGowan and colleagues concluded that ongoing risk-reduction counseling and substance abuse treatment for HIV patients need to be part of the solution. "I think what we need to do is make a safe-sex counseling message an ongoing part of clinical care," he said, "not counseling once a year. We need to do it much more often in a proactive way." He noted that monotonous warnings can lead to "fatigue" and cited a need to develop motivational interviewing skills and techniques to engage patients and encourage them to set achievable goals. "Prevention and treatment have to go hand in hand," he said.

The article, "Risk Behavior for Transmission of Human Immunodeficiency Virus (HIV) Among HIV-Seropositive Individuals in an Urban Setting," appears in Clinical Infectious Diseases (2004;38:122-127).

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