In the four months before any behavioral intervention, the 387 HIV-positive
individuals in the study reported having an average of 14 unprotected sex acts.
Twelve months later, the average had dropped to four unprotected sex acts.
Three different counseling interventions were tested in the study, and all
produced the same average decrease in unprotected sex a year later, say Thomas
L. Patterson, Ph.D., of the University of California, San Diego, and colleagues.
Few studies have measured the success of behavioral interventions with HIV-positive
individuals, say the researchers, but targeting this relatively small population
might make HIV prevention efforts more cost-effective.
“Vaccines to protect against infections with HIV remain elusive, and
behavioral interventions continue to be the best hope for slowing the AIDS
pandemic,” Patterson says.
The 387 individuals, mostly white, male and gay or bisexual, were chosen at
random to receive one of three different behavioral interventions that focused
on using condoms, negotiating safer sex practices and telling their partners
about their HIV-positive status.
One group participated in a single intensive counseling
session that discussed all three issues, one group received a more targeted
session discussing only
the issues that were identified as a problem by the participant, and a third
group received intensive counseling plus two similar “booster” sessions.
Although each group reported the same average number of unprotected sex acts
a year later, the group receiving the booster sessions reported an upswing
in unprotected sex eight months after intervention.
The booster group had the largest percentage of individuals taking antiretroviral
drugs, which may help explain the increase, say Patterson and colleagues. Previous
studies suggest that the availability of antiretrovirals and other improvements
in AIDS treatments have led to less frequent safe sex among some individuals.
“However, the changing pattern of results revealed over the 12-month
period emphasizes the need for longer term follow-up to provide adequate time
to examine the possible deterioration of intervention effects,” Patterson
says.
The researchers say they still don’t know whether these behavior changes
were related to HIV infection rates among the participants’ partners.
“Although it is impossible to estimate the number of new infections
averted by our intervention, we assert that prevention success even in small
numbers is significant in terms of reduced human suffering,” the researchers
say.
The study was published in the Annals of Behavioral
Medicine and supported
by the National Institute of Mental Health and the Department of Veterans Affairs.
