Multi-pronged approach curbs risky sex in the HIV+

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Programs intended to help individuals infected with HIV, the virus that causes AIDS, to reduce their sexual risk work best if they include training on skills like how to use a condom, as well as motivational training designed to boost social support or otherwise improve overall quality of life, a review of studies suggests.

But Dr. Blair T. Johnson of the Center for Health/HIV Intervention and Prevention at the University of Connecticut in Storrs and colleagues found that interventions including skills and motivational components have actually not been tested in HIV-positive men who have sex with men. “We don’t really know how good prevention could be with them,” Johnson told Reuters Health.

Motivational components might include information that would help an HIV-positive person feel optimistic about the future, Johnson explained. Basically, this approach is intended to give a person a sense that it’s worth it to “keep their guard up and act safe,” he added.

Johnson and his team reviewed 15 studies including a total of 3,234 participants, all of which tested the effectiveness of a particular approach to reducing sexual risk behavior among HIV-infected individuals. To date, they note in their report in the Journal of the Acquired Immune Deficiency Syndromes, evidence for such programs’ effectiveness has been “mixed.”

On average, the researchers found, the interventions increased participants’ condom use by 16 percent, but had no effect on their number of sexual partners. The programs’ effectiveness varied widely. Those that included a motivational component and skills training along with information on risk increased condom use by 32 percent, compared to just 5 percent for interventions that provided information only.

Younger people also showed more of a response to the interventions. Twenty-year-olds were 53 percent more likely to use condoms, on average, after participating, compared to an 11 percent increase in condom use among 40-year-olds.

Johnson and his team hypothesize that older people may tend to be in longer-term partnerships, “a factor that is known to increase resistance to change.”

Overall, the researchers found, interventions were not effective for men who have sex with men. But because none of the studies that included this population featured motivational and skills components, they add, it’s not clear if these approaches would be helpful, and there’s no evidence to show that men who have sex with men are as a rule less responsive to such efforts.

“Perhaps the most surprising finding of this work is that more than two decades into the epidemic, there have been so few intervention randomized controlled trials that focus on people living with HIV,” the researchers note.

However, Johnson told Reuters Health, several such trials are underway. “I think this problem will be rectified very soon.”

SOURCE: Journal of Acquired Immune Deficiency Syndromes, April 15, 2006.

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