The Cost and Intensity of Behavioral Interventions to Promote HIV Treatment for Prevention Among HIV-Positive Men Who Have Sex with Men
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Recently, behavioral prevention interventions for HIV have been criticized as being ineffective, costly, or inefficient. In this commentary, using HIV-positive men who have sex with men (MSM) as an illustrative high-risk population, we argue that the opposite is true—that behavioral interventions for HIV prevention, if implemented with the populations who need them, are affordable and critical for future prevention efforts. We base this argument on recent evidence showing that (1) adherence to antiretroviral treatment (ART) for prevention purposes is necessary to suppress HIV replication and reduce transmissibility, (2) individuals living with HIV have multiple psychosocial concerns that impact self-care and moderate the potential effectiveness of health behavior interventions, and (3) intensive interventions targeting both concerns together (psychosocial and HIV care) can show clinically significant improvement. We follow by comparing the cost of these types of interventions to the cost of standard clinical treatment for HIV with ART and demonstrate a cost-savings of potential intensive behavioral interventions for, in this case, HIV-positive MSM who have uncontrolled virus. Keeping this evidence in mind, we conclude that individual intervention must remain a mainstay of HIV prevention for certain critical populations.
KeywordsHIV Intervention Prevention Cost Syndemic Sexual orientation
Support for author time on the article came from National Institutes of Health Grants K24MH094214 and P30AI060354 awarded to the first author and K23MH096647 to the third author.
- Blashill, A. J., Bedoya, C. A., Mayer, K. H., O’Cleirigh, C., Pinkston, M., Remmert, J. E., … Safren, S. A. (2014). Psychosocial syndemics are additively associated with worse ART adherence in HIV-infected individuals. AIDS and Behavior. doi: 10.1007/s10461-014-0925-6.
- Brennan, J., Kuhns, L. M., Johnson, A. K., Belzer, M., Wilson, E. C., & Garofalo, R. (2012). Syndemic theory and HIV-related risk among young transgender women: The role of multiple, co-occurring health problems and social marginalization. American Journal of Public Health, 102, 1751–1757.Google Scholar
- Centers for Disease Control and Prevention. (2012a). Estimated HIV incidence in the United States, 2007–2010. Retrieved from http://www.cdc.gov/hiv/topics/surveillance/resources/reports/#supplemental.
- Centers for Disease Control and Prevention. (2012b). HIV in the United States: The stages of care. http://www.cdc.gov/hiv/pdf/research_mmp_stagesofcare.pdf.
- Centers for Disease Control and Prevention. (2013a). HIV Surveillance Report, 2011. Retrieved from http://www.cdc.gov/hiv/topics/surveillance/resources/reports/.
- Centers for Disease Control and Prevention. (2013b). Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas—2011. http://184.108.40.206/hiv/pdf/surveillance_Report_vol_19_no_3.pdf.
- Chiles, J. A., Lambert, M. J., & Hatch, A. L. (1999). The impact of psychological interventions on medical cost offset: A meta-analytic review. Clinical Psychology: Science and Practice, 6, 204–220.Google Scholar
- Crepaz, N., Lyles, C. M., Wolitski, R. J., Passin, W. F., Rama, S. M., Herbst, J. H., & HIV, AIDS Prevention Research Synthesis (PRS) Team. (2006). Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS, 20, 143–157.CrossRefPubMedGoogle Scholar
- Crepaz, N., Marks, G., Liau, A., Mullins, M. M., Aupont, L. W., Marshall, K. J., … HIV/AIDS Prevention Research Synthesis (PRS) Team. (2009). Prevalence of unprotected anal intercourse among HIV-diagnosed MSM in the United States: A meta-analysis. AIDS, 23(13), 1617–1629. doi: 10.1097/QAD.0b013e32832effae.
- Herbst, J. H., Beeker, C., Mathew, A., McNally, T., Passin, W. F., Kay, L. S., & Johnson, R. L. (2007). The effectiveness of individual-, group-, and community-level HIV behavioral risk-reduction interventions for adult men who have sex with men: A systematic review. American Journal of Preventive Medicine, 32, 38–67.CrossRefGoogle Scholar
- Herbst, J. H., Sherba, R. T., Crepaz, N., DeLuca, J. B., Zohrabyan, L., Stall, R. D., & HIV, AIDS Prevention Research Synthesis Team. (2005). A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 39, 228–241.PubMedGoogle Scholar
- Mattson, C. L., Freedman, M., Fagan, J. L., Frazier, E. L., Beer, L., Huang, P., … Medical Monitoring Project. (2014). Sexual risk behaviour and viral suppression among HIV-infected adults receiving medical care in the United States. AIDS, 28(8), 1203–1211. doi: 10.1097/QAD.0000000000000273.
- Mayer, K. H., Skeer, M. R., O’Cleirigh, C., Goshe, B. M., & Safren, S. A. (2014). Factors associated with amplified HIV transmission behavior among American men who have sex with men engaged in care: Implications for clinical providers. Annals of Behavioral Medicine, 47, 165–171.PubMedCentralCrossRefPubMedGoogle Scholar
- Meyer, J. P., Springer, S. A., & Altice, F. L. (2011). Substance abuse, violence, and HIV in women: A literature review of the syndemic. Journal of Women's Health, 20, 991–1006.Google Scholar
- Mimiaga, M. J., Noonan, E., Donnell, D., Safren, S. A., Koenen, K. C., Gortmaker, S., & Mayer, K. H. (2009). Childhood sexual abuse is highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE study. Journal of Acquired Immune Deficiency Syndromes, 51, 340–348.PubMedCentralCrossRefPubMedGoogle Scholar
- Mizuno, Y., Purcell, D. W., Knowlton, A. R., Wilkinson, J. D., Gourevitch, M. N., & Knight, K. R. (2015). Syndemic vulnerability, sexual and injection risk behaviors, and HIV continuum of care outcomes in HIV-positive injection drug users. AIDS and Behavior, 19(4), 684–693.Google Scholar
- Operario, D., & Nemoto, T. (2010). HIV in transgender communities: Syndemic dynamics and a need for multicomponent interventions. Journal of Acquired Immune Deficiency Syndromes, 55(Suppl 2), S91–S93.Google Scholar
- Pence, B. W., Mugavero, M. J., Carter, T. J., Leserman, J., Thielman, N. M., Raper, J. L., … Whetten, K. (2012). Childhood trauma and health outcomes in HIV-infected patients: An exploration of causal pathways. Journal of Acquired Immune Deficiency Syndromes, 59(4), 409–416. doi: 10.1097/QAI.0b013e31824150bb.CrossRefGoogle Scholar
- Rodger, A., Bruun, T., Cambiano, V., Vernazza, P., Estrada, V., Van Lunzen, J., … PARTNER Study Group. (2014). HIV transmission risk through condomless sex if HIV + partner on suppressive ART: PARTNER Study. Presented at the Conference on Retroviruses and Opportunistic Infections, Boston, MA.Google Scholar
- Rosser, B. S., Hatfield, L. A., Miner, M. H., Ghiselli, M. E., Lee, B. R., & Welles, S. L. (2010). Effects of a behavioral intervention to reduce serodiscordant unsafe sex among HIV positive men who have sex with men: The Positive Connections randomized controlled trial study. Journal of Behavioral Medicine, 33, 147–158.CrossRefPubMedGoogle Scholar
- Safren, S. A., Mayer, K. H., Ou, S., McCauley, M., Grinsztejn, B., Hosseinipour, M., & HPTN 052 Study Team. (2015). Adherence to early antiretroviral therapy: Results from HPTN 052, a phase III, multinational randomized trial of ART to prevent HIV-1 sexual transmission in serodiscordant couples. Journal of Acquired Immune Deficiency Syndromes, 69(2), 234–240.Google Scholar
- Safren, S. A., O’Cleirigh, C. M., Bullis, J. R., Otto, M. W., Stein, M. D., & Pollack, M. H. (2012). Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 80, 404–415.PubMedCentralCrossRefPubMedGoogle Scholar
- Safren, S. A., O’Cleirigh, C., Skeer, M. R., Driskell, J., Goshe, B. M., Covahey, C., & Mayer, K. H. (2011b). Demonstration and evaluation of a peer-delivered, individually-tailored, HIV prevention intervention for HIV-infected MSM in their primary care setting. AIDS and Behavior, 15, 949–958.CrossRefPubMedGoogle Scholar
- Safren, S. A., O’Cleirigh, C. M., Skeer, M., Elsesser, S. A., & Mayer, K. H. (2013). Project Enhance: A randomized controlled trial of an individualized HIV prevention intervention for HIV-infected men who have sex with men conducted in a primary care setting. Health Psychology, 32, 171–179.PubMedCentralCrossRefPubMedGoogle Scholar
- Safren, S. A., O’Cleirigh, C., Tan, J. Y., Raminani, S. R., Reilly, L. C., Otto, M. W., & Mayer, K. H. (2009). A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychology, 28, 1–10.PubMedCentralCrossRefPubMedGoogle Scholar
- Simoni, J. M., Pearson, C. R., Pantalone, D. W., Marks, G., & Crepaz, N. (2006). Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load: A meta-analytic review of randomized controlled trials. Journal of Acquired Immune Deficiency Syndromes, 43, S23–S35.PubMedCentralCrossRefPubMedGoogle Scholar
- Skeer, M. R., Mimiaga, M. J., Mayer, K. H., O’Cleirigh, C., Covahey, C., & Safren, S. A. (2012). Patterns of substance use among a large urban cohort of HIV-infected men who have sex with men in primary care. AIDS and Behavior, 16(3), 676–689. doi: 10.1007/s10461-011-9880-7.PubMedCentralCrossRefPubMedGoogle Scholar
- Stall, R., Mills, T. C., Williamson, J., Hart, T., Greenwood, G., Paul, J., & Catania, J. A. (2003). Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. American Journal of Public Health, 93, 939–942.PubMedCentralCrossRefPubMedGoogle Scholar
- Welles, S. L., Baker, A. C., Miner, M. H., Brennan, D. J., Jacoby, S., & Rosser, B. S. (2009). History of childhood sexual abuse and unsafe anal intercourse in a 6-city study of HIV-positive men who have sex with men. American Journal of Public Health, 99, 1079–1086.PubMedCentralCrossRefPubMedGoogle Scholar