HIV/STD Prevention Counseling for HIV+ Adults in the US
HIV/STD Prevention Counseling for HIV+ Adults in the US
Objective: Guidelines recommend risk-reduction counseling by HIV providers to all HIV-infected persons. Among HIV-infected adults receiving medical care in the United States, we estimated prevalence of exposure to three types of HIV/sexually transmitted disease (STD) risk-reduction interventions and described the characteristics of persons who received these interventions.
Design: Data were from the Medical Monitoring Project (MMP), a supplemental HIV surveillance system designed to produce nationally representative estimates of behavioral and clinical characteristics of HIV-infected adults receiving medical care in the United States.
Methods: Descriptive analyses were conducted to estimate the exposure to each type of HIV/STD risk-reduction intervention. Bivariate and multivariable analyses were conducted to assess associations between the selected correlates with each exposure variable.
Results: About 44% of participants reported a one-on-one conversation with a healthcare provider about HIV/STD prevention, 30% with a prevention program worker, 16% reported participation in a small group risk-reduction intervention, and 52% reported receiving at least one of the three interventions in the past 12 months. Minority race/ethnicity, low income, and risky sexual behavior consistently predicted greater intervention exposure. However, 39% of persons who reported risky sex did not receive any HIV/STD risk-reduction interventions.
Conclusions: HIV-infected persons in care with fewer resources or those who engaged in risk behaviors were more likely to receive HIV/STD risk-reduction interventions. However, less than half of HIV-infected persons in care received HIV/STD prevention counseling from their provider, an intervention that has been shown to be effective and is supported by guidelines.
More than 1.1 million persons are living with HIV (PLWH) in the United States. Although many PLWH reduce risk behaviors after learning that they are infected, some continue to engage in risky behavior at some point after their diagnosis. Maintaining safer behaviors over a lifetime can be challenging. Providing prevention interventions that reduce the risk of HIV transmission or acquisition of other sexually transmitted diseases (STDs), in addition to HIV treatment and care for improving the health of PLWH are critical components of the US National HIV/AIDS Strategy (NHAS).
Meta-analyses show that behavioral interventions for PLWH significantly reduce sexual risk behaviors. Research trials have shown evidence that brief one-on-one HIV risk-reduction interventions delivered by providers/clinicians during clinical care visits can reduce sexual risk behaviors of HIV-positive patients. Evidence-based recommendations and clinical guidelines emphasize that healthcare providers in clinic settings should offer prevention counseling during routine clinic visits to all PLWH regarding how they can protect themselves or their partners from getting HIV and other STDs. However, little is known regarding what percentage of PLWH who receive care in the United States have been exposed to HIV prevention counseling and whether prevention counseling is reaching PLWH who need it.
The primary objective of this article is to estimate prevalence of exposure to individual-level HIV/STD prevention counseling provided by healthcare workers, individual-level HIV/STD prevention counseling provided by prevention program workers, and small group HIV/STD risk-reduction interventions. These are the types of behavioral risk-reduction interventions that are more commonly implemented in clinical and nonclinical settings. The second objective is to describe the characteristics of the PLWH who received each of the risk-reduction interventions. We were particularly interested in determining whether HIV-infected persons who had fewer socioeconomic resources and engaged in high-risk sexual and drug using behavior were more or less likely to receive these interventions. These findings can provide information on the reach of HIV/STD risk-reduction interventions among PLWH receiving medical care in the United States and whether these behavioral interventions are appropriately targeted.
Abstract and Introduction
Abstract
Objective: Guidelines recommend risk-reduction counseling by HIV providers to all HIV-infected persons. Among HIV-infected adults receiving medical care in the United States, we estimated prevalence of exposure to three types of HIV/sexually transmitted disease (STD) risk-reduction interventions and described the characteristics of persons who received these interventions.
Design: Data were from the Medical Monitoring Project (MMP), a supplemental HIV surveillance system designed to produce nationally representative estimates of behavioral and clinical characteristics of HIV-infected adults receiving medical care in the United States.
Methods: Descriptive analyses were conducted to estimate the exposure to each type of HIV/STD risk-reduction intervention. Bivariate and multivariable analyses were conducted to assess associations between the selected correlates with each exposure variable.
Results: About 44% of participants reported a one-on-one conversation with a healthcare provider about HIV/STD prevention, 30% with a prevention program worker, 16% reported participation in a small group risk-reduction intervention, and 52% reported receiving at least one of the three interventions in the past 12 months. Minority race/ethnicity, low income, and risky sexual behavior consistently predicted greater intervention exposure. However, 39% of persons who reported risky sex did not receive any HIV/STD risk-reduction interventions.
Conclusions: HIV-infected persons in care with fewer resources or those who engaged in risk behaviors were more likely to receive HIV/STD risk-reduction interventions. However, less than half of HIV-infected persons in care received HIV/STD prevention counseling from their provider, an intervention that has been shown to be effective and is supported by guidelines.
Introduction
More than 1.1 million persons are living with HIV (PLWH) in the United States. Although many PLWH reduce risk behaviors after learning that they are infected, some continue to engage in risky behavior at some point after their diagnosis. Maintaining safer behaviors over a lifetime can be challenging. Providing prevention interventions that reduce the risk of HIV transmission or acquisition of other sexually transmitted diseases (STDs), in addition to HIV treatment and care for improving the health of PLWH are critical components of the US National HIV/AIDS Strategy (NHAS).
Meta-analyses show that behavioral interventions for PLWH significantly reduce sexual risk behaviors. Research trials have shown evidence that brief one-on-one HIV risk-reduction interventions delivered by providers/clinicians during clinical care visits can reduce sexual risk behaviors of HIV-positive patients. Evidence-based recommendations and clinical guidelines emphasize that healthcare providers in clinic settings should offer prevention counseling during routine clinic visits to all PLWH regarding how they can protect themselves or their partners from getting HIV and other STDs. However, little is known regarding what percentage of PLWH who receive care in the United States have been exposed to HIV prevention counseling and whether prevention counseling is reaching PLWH who need it.
The primary objective of this article is to estimate prevalence of exposure to individual-level HIV/STD prevention counseling provided by healthcare workers, individual-level HIV/STD prevention counseling provided by prevention program workers, and small group HIV/STD risk-reduction interventions. These are the types of behavioral risk-reduction interventions that are more commonly implemented in clinical and nonclinical settings. The second objective is to describe the characteristics of the PLWH who received each of the risk-reduction interventions. We were particularly interested in determining whether HIV-infected persons who had fewer socioeconomic resources and engaged in high-risk sexual and drug using behavior were more or less likely to receive these interventions. These findings can provide information on the reach of HIV/STD risk-reduction interventions among PLWH receiving medical care in the United States and whether these behavioral interventions are appropriately targeted.
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