A Behavioral Intervention Reduces HIV Transmission Risk by Promoting Sustained Serosorting Practices Among HIV-Infected Men Who Have Sex With Men

Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA 94105, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 12/2008; 49(5):544-51. DOI: 10.1097/QAI.0b013e31818d5def
Source: PubMed


To examine factors that explain the effect of a cognitive-behavioral intervention on reductions in HIV transmission risk among HIV-infected men who have sex with men (MSM).
Of the 1910 HIV-infected MSM screened, 616 participants considered to be at risk of transmitting HIV were randomized to a 15-session, individually delivered cognitive-behavioral intervention (n=301) or a wait-list control (n=315).
Consistent with previous intent-to-treat findings, there was an overall reduction in transmission risk acts among MSM in both intervention and control arms, with significant intervention effects observed at the 5-, 10-, 15-, and 20-month assessments (risk ratios=0.78, 0.62, 0.48, and 0.38, respectively). These intervention-related decreases in HIV transmission risk acts seemed to be partially due to sustained serosorting practices. MSM in the intervention condition reported a significantly greater proportion of sexual partners who were HIV infected at the 5- and 10-month assessments (risk ratios=1.14 and 1.18).
The Healthy Living Project, a cognitive-behavioral intervention, is efficacious in reducing transmission risk acts among MSM. This seems to have been due in large part to the fact that MSM in the intervention condition reported sustained serosorting practices.

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Available from: Mallory O'Neill Johnson
    • "For other groups, special factors may alter the nature of the definition. For example, infected persons are at risk to transmit infection and therefore positive experiences for all parties implies added attention to disclosure and transmission risk reduction (e.g., Morin et al., 2008). Because sexual health remains conceptually attainable for vulnerable populations, we retained interventions with such groups if the intervention otherwise met sexual health criteria even if the intervention focus was attuned to the sample's immediate needs, such as risk reduction. "
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    ABSTRACT: Recent work has explored the intersection between sexual health (as construed by the World Health Organization and others) and public health domains of action in the United States of America. This article reports the narrative results of a systematic review of sexual health intervention effects on public health-relevant outcomes. To qualify, interventions had to be based on the principles (1) that sexual health is intrinsic to individuals and their overall health and (2) that relationships reflecting sexual health must be positive for all parties concerned. Outcomes were classed in domains: knowledge, attitudes, communication, health care use, sexual behavior, and adverse events. We summarized data from 58 studies (English language, adult populations, 1996-2011) by population (adults, parents, sexual minorities, vulnerable populations) across domains. Interventions were predominantly individual and small-group designs that addressed sexual behaviors (72%) and attitudes/norms (55%). They yielded positive effects in that 98% reported a positive finding in at least one domain; 50% also reported null effects. The most consistently positive effects on behaviors and adverse events were found for sexual minorities, vulnerable populations, and parental communication. Whether via direct action or through partnerships, incorporating principles from existing sexual health definitions in public health efforts may help improve sexual health.
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    • "Recent HIV prevention research has focused on methods to promote frequent HIV testing and awareness of HIV status. Individuals who are aware of their HIV-positive status may be more inclined to modify risky behaviors associated with HIV infection and transmission (e.g., unprotected sex or serodiscordant partner selection) [11], [12]. Moreover, diagnosis of HIV infection is conducive to timely treatment with anti-retroviral therapy (ART), which can suppress viral loads and reduce population-level HIV transmission [13]–[15]. "
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    • "Of the other three studies published since the meta-analysis (Mausbach, Semple, Strathdee, Zians, & Patterson, 2007; Morin et al., 2008; Simon Rosser et al., 2010), all found reductions in both the intervention and control groups, with just one finding statistically significant differential improvements favoring the intervention under study (Morin et al., 2008). The one that did find differential improvements, " The Healthy Living Project, " addressed a variety of psychosocial concerns as part of living with HIV, and was considerably more intense, consisting of fifteen 90-min long individual sessions with a counselor (Morin et al., 2008). "
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