Is HIV/Sexually Transmitted Disease Prevention Counseling Effective Among Vulnerable Populations?

Bolu, Omotayo; Lindsey, Catherine; Kamb, Mary L.; Kent, Charlotte K.; Zenilman, Jonathan M.; Douglas, John M.; Malotte, C. Kevin; Rogers, Judy; Peterman, Thomas A.

doi:10.1097/01.olq.0000135987.12346.f2

Cited by 49 publications

(28 citation statements)

References 25 publications

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“…25 Approximately 92% of the AHI patients diagnosed with a STI during follow-up were MSM, suggesting tailored risk prevention interventions are needed to address ongoing risk behaviors in this group. 26,27 Finally, these data strongly support the importance of ART initiation in those diagnosed with AHI, as specifically recommended in revised guidelines, 22 to reduce the risk of onward HIV transmission in the presence of continued high risk sexual behavior.…”

Section: Discussionmentioning

confidence: 57%

Incident Sexually Transmitted Infection as a Biomarker for High-Risk Sexual Behavior After Diagnosis of Acute HIV

Cope

Crooks

Chin

et al. 2014

Sexually Transmitted Diseases

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Background Sexually transmitted infection (STI) diagnosis following diagnosis of acute HIV infection (AHI) indicates ongoing high-risk sexual behavior and possible risk of HIV transmission. We assessed predictors of STI acquisition and the effect of time since care entry on STI incidence in AHI patients in care and receiving consistent risk-reduction messaging. Methods Data on incident gonorrhea, chlamydia, trichomoniasis, primary/secondary syphilis, demographic, and clinical risk factors were abstracted from medical charts for patients diagnosed with AHI and engaged in care. Poisson regression models using generalized estimating equations were fit to estimate incidence rates (IR), incidence rate ratios (IRR), and robust 95% confidence intervals (CI). Results Among 185 AHI patients, 26 (14%) were diagnosed with ≥1 incident STI over 709.4 person-years; 46 STIs were diagnosed during follow-up (IR=6.8/100 person-years). The median time from HIV care entry to first STI diagnosis was 609 days (range=168–1681). Men who have sex with men (MSM) (p=0.03), a shorter time between presentation to medical care and AHI diagnosis (p=0.06), and STI diagnosis prior to AHI diagnosis (p=0.0003) were predictors of incident STI. STI IR >1 year after entering care was double that of patients in care ≤1 year (IRR=2.0 95% CI 0.8–4.9). HIV viral load was above the limits of detection within 1 month of 11 STI diagnoses in 6 patients (23.1%) (median=15,898 copies/mL, range=244–152,000 copies/mL). Conclusions Despite regular HIV care, STI incidence was high among this primarily young, MSM AHI cohort. Early antiretroviral initiation may decrease HIV transmission given ongoing risk behaviors despite risk-reduction messaging.

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Section: Discussionmentioning

confidence: 57%

Incident Sexually Transmitted Infection as a Biomarker for High-Risk Sexual Behavior After Diagnosis of Acute HIV

Cope

Crooks

Chin

et al. 2014

Sexually Transmitted Diseases

View full text Add to dashboard Cite

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“…Prevention remains the best strategy against HIV. Research has previously demonstrated that counseling is effective in helping people change their behaviors to prevent transmission of HIV [49], [50]; moreover, even brief, client-centered risk reduction counseling reduced both HIV risk behavior [49] and STD incidence [49], [51] compared to didactic informational prevention messages. Given that a major rationale for the CDC's revised recommendations is to detect HIV infection in individuals who either have never tested before, or who avoid retesting despite engaging in risk behavior, the need for pretest disclosures and counseling may be more important than ever, at least in the short term.…”

Section: Discussionmentioning

confidence: 99%

Implementing Routine HIV Testing: The Role of State Law

2007

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In September 2006, the Centers for Disease Control and Prevention (CDC) recommended routine HIV testing for all Americans aged 13–64, which would eliminate requirements for written consent and pretest counseling as previously required. However, this approach may conflict with state requirements concerning pretest counseling and informed consent for HIV testing. Our survey of state HIV testing laws demonstrates that the majority of states have HIV testing requirements that are inconsistent with the CDC's recommendations. Moreover, states that have recently amended their laws have not eased the requirements for pretest counseling and informed consent. The reasons for the persistence of these legal requirements must be understood to effect policy changes to increase HIV testing.

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“…In total, 18 subgroups within four different domains were analyzed; they were selected based on evidence in the literature suggesting that various characteristics are associated with sexual risk behavior and/or HIV prevalence. Subgroups based on demographic characteristics included age [37–39], race/ethnicity [12, 38, 40], biological sex [38], income, [41] and education [41]. Subgroups based on attitudes and perceptions included readiness to use condoms [42], perceived risk for HIV [43, 44], condom use self-efficacy [45, 46], and attitudes toward condoms/safer sex [47].…”

Section: Methodsmentioning

confidence: 99%

Examining the Efficacy of HIV Risk-Reduction Counseling on the Sexual Risk Behaviors of a National Sample of Drug Abuse Treatment Clients: Analysis of Subgroups

et al. 2016

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HIV counseling with testing has been part of HIV prevention in the U.S. since the 1980s. Despite the long-standing history of HIV testing with prevention counseling, the CDC released HIV testing recommendations for health care settings contesting benefits of prevention counseling with testing in reducing sexual risk behaviors among HIV-negatives in 2006. Efficacy of brief HIV risk-reduction counseling (RRC) in decreasing sexual risk among subgroups of substance use treatment clients was examined using multisite RCT data. Interaction tests between RRC and subgroups were performed; multivariable regression evaluated the relationship between RRC (with rapid testing) and sex risk. Subgroups were defined by demographics, risk type and level, attitudes/perceptions, and behavioral history. There was an effect (p < .0028) of counseling on number of sex partners among some subgroups. Certain subgroups may benefit from HIV RRC; this should be examined in studies with larger sample sizes, designed to assess the specific subgroup(s).

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Is HIV/Sexually Transmitted Disease Prevention Counseling Effective Among Vulnerable Populations?

Abstract: HIV/STD prevention counseling (brief or enhanced counseling) resulted in fewer STDs than educational messages for all subgroups of STD clinic clients, including high-risk groups such as adolescents and persons with STDs at enrollment.

Cited by 49 publications

References 25 publications

Incident Sexually Transmitted Infection as a Biomarker for High-Risk Sexual Behavior After Diagnosis of Acute HIV

Incident Sexually Transmitted Infection as a Biomarker for High-Risk Sexual Behavior After Diagnosis of Acute HIV

Implementing Routine HIV Testing: The Role of State Law

Examining the Efficacy of HIV Risk-Reduction Counseling on the Sexual Risk Behaviors of a National Sample of Drug Abuse Treatment Clients: Analysis of Subgroups

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