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The Cost and Intensity of Behavioral Interventions to Promote HIV Treatment for Prevention Among HIV-Positive Men Who Have Sex with Men

  • Special Section: Sexual Health In Gay And Bisexual Men
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Abstract

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.

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Acknowledgments

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.

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Authors and Affiliations

  1. Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Steven A. Safren, Nicholas S. Perry, Aaron J. Blashill & Conall O’Cleirigh

  2. Fenway Health, Boston, MA, USA

    Steven A. Safren, Aaron J. Blashill, Conall O’Cleirigh & Kenneth H. Mayer

  3. Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., P.O. Box 248185, Coral Gables, FL, 33124, USA

    Steven A. Safren

  4. Department of Psychology, San Diego State University, San Diego, CA, USA

    Aaron J. Blashill

  5. Department of Psychology, University of Utah, Salt Lake City, UT, USA

    Nicholas S. Perry

  6. Department of General Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA

    Kenneth H. Mayer

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  1. Steven A. Safren
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  2. Nicholas S. Perry
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  3. Aaron J. Blashill
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  4. Conall O’Cleirigh
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  5. Kenneth H. Mayer
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Correspondence to Steven A. Safren.

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Safren, S.A., Perry, N.S., Blashill, A.J. et al. The Cost and Intensity of Behavioral Interventions to Promote HIV Treatment for Prevention Among HIV-Positive Men Who Have Sex with Men. Arch Sex Behav 44, 1833–1841 (2015). https://doi.org/10.1007/s10508-014-0455-3

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