CHICAGO - In trying to reduce the spread of HIV in this country, healthcare providers need to start targeting those who are infected, as well as those who are not, suggests research presented at the 40th annual meeting of the Infectious Diseases Society of America (IDSA) in October 2002.
"With improvements in therapy, HIV has become a chronic disease that can be managed, allowing infected people to feel and act well. Possibly related to this, the incidence of unsafe sex among HIV-positive people is on the rise," said Laura H. Bachmann, MD, MPH, assistant professor of medicine, epidemiology and international health, at the University of Alabama at Birmingham Schools of Medicine and Public Health. "We and other health care providers see HIV-positive people approximately every three months at our clinics and until relatively recently, we've had to focus on keeping them alive and well. With more recent therapeutic advances, we need to start talking to them about changing their sexual behavior. This is a very different prevention focus from telling people who are not infected to get tested and use condoms to protect themselves.
"The majority of people in our study practiced safe sex by wearing a condom or didn't have sex at all, but a substantial number continue to practice risky behavior," she said. "We're going to have to find ways to encourage changes in behavior, but we'll have to tailor it to the individual."
In the study of 248 HIV-positive men (77 percent who had sex with men, 23 percent who were heterosexual), about a third said they had recently engaged in unprotected anal or vaginal sex, and more than 80 percent did not use condoms during oral sex. In the cases of unprotected sex, more than half of the partners were either HIV negative or their HIV status was not known.
It's important for healthcare workers to get to the crux of the reason for the risky behavior. Reasons given for risky behavior may vary from not liking condoms to the desire to be more intimate with their partners than they fear condoms would allow. In some cases, it may well be that the infected person does not have all of the facts.
"Some patients incorrectly think they can't transmit the HIV virus as long as it's undetectable in their blood," she said. "One strategy to address the problem might be to warn HIV-positive people of the further health risk of unprotected sex to them. For instance, they are vulnerable to contracting other sexually transmitted diseases, such as gonorrhea or syphilis, or becoming HIV superinfected by contracting another strain of the virus that might not be as amenable to therapy."
Co-authors of a paper on the topic presented at IDSA by Bachmann were Diane M. Grimley, Yvonne Waithaka, Sten H. Vermund, Michael S. Saag and Edward W. Hook III.
The HIV Medicine Association of IDSA (HIVMA) represents more than 2,400 physicians, researchers, scientists and other health care professionals dedicated to HIV/AIDS care, research and prevention. One of HIVMA's key initiatives is a collaboration with the Centers for Disease Control and Prevention (CDC) to integrate HIV prevention, particularly to those already infected, into various aspects of clinical care.