HIV-AIDS Counseling: Focus on Risk-Takers First

An estimated 1 million persons are living with HIV in the United States.¹ Several meta-analyses demonstrate the effectiveness of behavioral interventions for reducing risky sexual behaviors.² Clinical trials, too, have shown that brief one-on-one HIV risk-reduction interventions during clinical care help reduce sexual risk-taking behaviors in HIV-infected patients.³

A recent study published in the journal AIDS⁴ estimated the prevalence of exposure to 3 different types of HIV/STD risk-reduction interventions among HIV-infected adults who receive care in the United States. The authors also described characteristics of persons who received each type of intervention. Participants were asked whether in the past 12 months they had: engaged in a one-on-one conversation with a health care provider to discuss ways to protect themselves or their partners from HIV infection or other STDs; had similar one-on-one conversations with an outreach worker, counselor, or prevention program worker; or participated in an organized small-group session to discuss protection from HIV infection/STDs.

The study found that over the preceding 12 months, fewer than half (44%) of patients who had a diagnosis of HIV infection for at least 1 year had a one-on-one conversation with a health care provider regarding HIV/STD prevention. About 30% reported they had been involved in a similar conversation with a prevention program worker, and only 16% reported participation in small-group interventions. Greater exposure to intervention was consistently predicted by minority race/ethnicity, low socioeconomic status, and risky sexual behavior. However, more than one-third (39%) of persons who reported risky sex did not receive any HIV/STD risk-reduction interventions. This study highlights important missed opportunities for this type of preventive counseling in the clinical setting.

Take-home message

HIV-infected patients who engage in high-risk sexual behaviors may need to be prioritized for risk-reduction intervention. Primary care physicians treating patients with HIV should be aware of the need to stratify the counseling needs of this vulnerable population.

References:

• Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data-United States and 6 U.S. dependent areas, 2010. HIV Surveillance Supplemental Report 2012; 17(No.3, part A). Published June 2012. 
• Crepaz N, Lyles CM, Wolitski RJ, et al. Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials.  AIDS. 2006;20:143–157.
• Fisher JD, Fisher WA, Cornman DH, et al. Clinician-delivered intervention during routine clinical care reduced unprotected sexual behavior among HIV-infected patients.J Acquir Immune Defic Syndr.2006;41:44–52.
• Mizuno Y, Zhu J, Crepaz N, et al. Receipt of HIV/sexually transmitted disease prevention counseling by HIV-infected adults receiving medical care in the United States, Medical Monitoring Project, 2009.AIDS. 2013 Sep 19. [Epub ahead of print]