AIDS and Behavior

, Volume 11, Supplement 1, pp 6–16 | Cite as

Predicting HIV Transmission Risk among HIV-Infected Patients Seen in Clinical Settings

  • Stephen F. Morin
  • Janet J. Myers
  • Starley B. Shade
  • Kimberly Koester
  • Andre Maiorana
  • Carol Dawson Rose
Original Paper

Abstract

We assessed risk of transmission among 4,016 HIV-infected patients in primary care, including men who have sex with men (MSM, n = 2,109), women (n = 1,104) and men who had sex with women (MSW, n = 803) in clinics in 15 cities across the U.S. A transmission risk act, assessed by computer assisted interviews, was defined as unprotected vaginal or anal sex with a partner who was HIV-uninfected or of unknown HIV status. MSM were more than twice as likely to report transmission risk acts than MSW (Odds Ratio [OR] = 2.35; 95% Confidence Interval [CI] = 1.84, 3.00; P ≤ .001). Women were also more likely to report transmission risk acts than MSW (OR = 1.56; 95% CI = 1.19, 2.05; P ≤ .001). Stimulant use was associated with transmission risk in all three groups (P ≤ .05). MSM were more likely to use methamphetamines (8% versus 2% and 3% respectively), while MSW (17%) and women (12%, compared to 11% for MSM) were more likely to use cocaine. Clinical settings offer opportunities for preventing HIV transmission, particularly if interventions are tailored to sub-populations of HIV-infected patients.

Keywords

HIV prevention with positives Clinical settings Transmission risk 

References

  1. Arnsten, J. H., Demas, P. A., Grant, R. W., Gourevitch, M. N., Farzadegan, H., Howard, A. A., et al. (2002). Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. Journal of General Internal Medicine, 17(5), 377–381.PubMedGoogle Scholar
  2. CDC (2003). Advancing HIV Prevention: Interim Technical Guidance for Selected Interventions. Atlanta: CDC.Google Scholar
  3. Colfax, G., Coates, T. J., Husnik, M. J., Huang, Y., Buchbinder, S., Koblin, B., et al. (2005). Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of san francisco men who have sex with men. Journal of Urban Health, 82(1 Suppl 1), i62–i70.PubMedGoogle Scholar
  4. Colfax, G. N., Vittinghoff, E., Grant, R., Lum, P., Spotts, G., & Hecht, F. M. (2007). Frequent methamphetamine use is associated with primary non-nucleoside reverse transcriptase inhibitor resistance. AIDS, 21(2), 239–241.PubMedCrossRefGoogle Scholar
  5. Ellis, R. J., Childers, M. E., Cherner, M., Lazzaretto, D., Letendre, S., & Grant, I. (2003). Increased human immunodeficiency virus loads in active methamphetamine users are explained by reduced effectiveness of antiretroviral therapy. Journal of Infectious Diseases, 188(12), 1820–1826.PubMedCrossRefGoogle Scholar
  6. Fisher, J. D., Cornman, D. H., Osborn, C. Y., Amico, K. R., Fisher, W. A., & Friedland, G. A. (2004). Clinician-initiated HIV risk reduction intervention for HIV-positive persons: Formative Research, Acceptability, and Fidelity of the Options Project. Journal of Acquired Immune Deficiency Syndromes, 37(Suppl 2), S78–87.PubMedGoogle Scholar
  7. Gribble, J. N., Miller, H. G., Rogers, S. M., & Turner, C. F. (1999). Interview mode and measurement of sexual behaviors: methodological issues. Journal of Sex Research, 36, 16–24.CrossRefGoogle Scholar
  8. Halkitis, P. N., Parsons, J. T., & Stirratt, M. J. (2001). A double epidemic: crystal methamphetamine drug use in relation to HIV transmission among gay men. Journal of Homosexuality, 41(2), 17–35.PubMedCrossRefGoogle Scholar
  9. Health Resources and Services Administration HIV/AIDS Bureau. (2004). Ryan White CARE Act Data Summery. Rockville: MD August 2006.Google Scholar
  10. Hinkin, C. H. et al. (2007). Drug use and medication adherence among HIV-1 infected individuals. AIDS and Behavior, 11(2), 185–194.PubMedCrossRefGoogle Scholar
  11. Institute of Medicine (2001). No time to lose: getting more from HIV prevention. Washington, DC: National Academy of Sciences.Google Scholar
  12. Kalichman, S. C., Rompa, D., & Cage, M. (2005). Group intervention to reduce HIV transmission risk behavior among persons living with HIV/AIDS. Behavior Modification, 29(2), 256–285.PubMedCrossRefGoogle Scholar
  13. Kalichman, S. C., Rompa, D., Cage, M., DiFonzo, K., Simpson, D., Austin, J., et al. (2001). Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people. American Journal of Preventive Medicine, 21(2), 84–92.PubMedCrossRefGoogle Scholar
  14. Koblin, B. A., Chesney, M. A., Husnik, M. J., Bozeman, S., Celum, C. L., Buchbinder, S., et al. (2003). High-risk behaviors among men who have sex with men in 6 US cities: baseline data from the EXPLORE Study. American Journal of Public Health, 93(6), 926–932.PubMedCrossRefGoogle Scholar
  15. Lyles, C. M. et al. (2007). Best-evidence interventions: findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2000–2004. American Journal of Public Health, 97(1), 133–143.PubMedCrossRefGoogle Scholar
  16. Morin, S. F., Koester, K. A., Steward, W. T., Maiorana, A., McLaughlin, M., Myers, J. J., et al. (2004). Missed Opportunities: Prevention With HIV-Infected Patients in Clinical Care Settings. Journal of Acquired Immune Deficiency Syndromes, 36(4), 960–966.PubMedCrossRefGoogle Scholar
  17. Morin, S. F., Steward, W. T., Charlebois, E. D., Remien, R. H., Pinkerton, S. D., Johnson, M. O., et al. (2005). Predicting HIV transmission risk among HIV-infected men who have sex with men: findings from the healthy living project. Journal of Acquired Immune Deficiency Syndromes, 40(2), 226–235.PubMedCrossRefGoogle Scholar
  18. Myers, J. J., Steward, W. T., Charlebois, E., Koester, K. A., Maiorana, A., & Morin, S. F. (2004). Written clinic procedures enhance delivery of HIV “Prevention With Positives” counseling in primary health care settings. Journal of Acquired Immune Deficiency Syndromes, 37(Suppl 2), S95–S100.PubMedGoogle Scholar
  19. Purcell, D. W. et al. (2004). Interventions for seropositive injectors-research and evaluation: an integrated behavioral intervention with HIV-positive injection drug users to address medical care, adherence, and risk reduction. Journal of Acquired Immune Deficiency Syndromes, 37(Suppl 2), S110–118PubMedGoogle Scholar
  20. Richardson, J. L., Milam, J., McCutchan, A., Stoyanoff, S., Bolan, R., Weiss, J., et al. (2004). Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment. AIDS, 18(8), 1179–1186.PubMedCrossRefGoogle Scholar
  21. Rotheram-Borus, M. J., Swendeman, D., Comulada, W. S., Weiss, R. E., Lee, M., & Lightfoot, M. (2004). Prevention for Substance-Using HIV-Positive Young People: Telephone and In-Person Delivery. Journal of Acquired Immune Deficiency Syndromes, 37(Suppl 2), S68–77.PubMedGoogle Scholar
  22. Steward, W. T., Koester, K. A., Myers, J. J., & Morin, S. F. (2006). Provider fatalism reduces the likelihood of HIV-prevention counseling in primary care settings. AIDS and Behavior, 10(1), 3–12.PubMedCrossRefGoogle Scholar
  23. The Healthy Living Project Team (2007). Effects of a behavioral intervention to reduce risk of transmission among people living with HIV: the healthy living project randomized controlled study. Journal of Acquired Immune Deficiency Syndromes, 44(2), 213–221.CrossRefGoogle Scholar
  24. Turner, C. F., Ku, L., Rogers, S. M., Lindberg, L. D., Pleck, J. H., & Sonenstein, F. L. (1998). Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology. Science, 280(5365), 867–873.PubMedCrossRefGoogle Scholar
  25. Weinhardt, L. S., Kelly, J. A., Brondino, M. J., Rotheram-Borus, M. J., Kirshenbaum, S. B., Chesney, M. A., et al. (2004). HIV transmission risk behavior among men and women living with HIV in 4 cities in the United States. Journal of Acquired Immune Deficiency Syndromes, 36(5), 1057–1066.PubMedCrossRefGoogle Scholar
  26. Westbrook, L., & Bauman, L. (1996). Perceived stigma of HIV/AIDS: Public view. Bronx, NY: Albert Einstein College of Medicine.Google Scholar
  27. Wingood, G. M., DiClemente, R. J., Mikhail, I., Lang, D. L., McCree, D. H., Davies, S. L., et al. (2004). A randomized controlled trial to reduce HIV transmission risk behaviors and sexually transmitted diseases among women living with HIV: The WiLLOW Program. Journal of Acquired Immune Deficiency Syndromes, 37(Suppl 2), S58–67.PubMedGoogle Scholar
  28. Wolitski, R. J., Gomez, C. A., & Parsons, J. T. (2005). Effects of a peer-led behavioral intervention to reduce HIV transmission and promote serostatus disclosure among HIV-seropositive gay and bisexual men. AIDS, 19(Suppl 1), S99–109.PubMedGoogle Scholar
  29. Wolitski, R. J., Parsons, J. T., Gomez, C. A., Purcell, D. W., Hoff, C. C., & Halkitis, P. N. (2005). Prevention with gay and bisexual men living with HIV: rationale and methods of the Seropositive Urban Men’s Intervention Trial (SUMIT). AIDS, 19(Suppl 1), S1–11.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Stephen F. Morin
    • 1
  • Janet J. Myers
    • 1
  • Starley B. Shade
    • 1
  • Kimberly Koester
    • 1
  • Andre Maiorana
    • 1
  • Carol Dawson Rose
    • 1
  1. 1.Center for AIDS Prevention StudiesUniversity of California, San FranciscoSan FranciscoUSA

Personalised recommendations