Interviews with 256 individuals who attended a New York City HIV clinic revealed that 41 percent engaged in unprotected sex after learning they were HIV positive, the study reports.
Trading sex for drugs or money was an important factor associated with high-risk behavior, particularly for women. Lead author Dr. Joseph P. McGowan of the Bronx-Lebanon Hospital Center in New York says HIV-positive women may be more likely to have unprotected sex because of a "lack of empowerment or low self esteem. For example," he said, "does the woman have the ability to say no if the man doesn't use a condom?" Often, said Dr. McGowan, the women have a history of exchanging sex for money or drugs, which probably led them to become HIV-positive initially. Such "survival sex" is a difficult-to-change habit fueled by both economic need and addiction.
Highly active antiretroviral therapy (HAART) patients were more likely to have unprotected sex than those who did not receive the treatment, perhaps because HAART patients believed they would not transmit HIV to their partners. However, said Dr. McGowan, although HAART can help decrease the risk of HIV transmission, the risk is not eliminated. In fact, a patient receiving HAART may transmit a drug-resistant form of HIV.
Reducing transmission of HIV is an intricate problem, said Dr. McGowan. In the study, Dr. McGowan and his colleagues concluded that ongoing risk-reduction counseling and substance abuse treatment for HIV-infected persons must be part of the solution. "I think what we need to do is make a safe sex counseling message an ongoing part of clinical care," he said, "not counseling once a year. We need to do it much more often in a proact
Contact: Jeff Minerd
Infectious Diseases Society of America