Sexual Behaviors and Sexual Risk in a Prospective Cohort of HIV-Positive Men and Women in New York City, 1994–2002: Implications for Prevention

Abstract

As an ever-increasing number of people infected with HIV are living longer, healthier lives, concerns about continued transmission are growing along with an awareness of the need to develop "prevention for positives." This study of HIV-positive adults in New York City is the first examination of patterns of sexual behavior in a large, representative cohort of HIV-infected individuals followed over an extended time period. A total of 968 HIV-positive adults were interviewed every 6-12 months between 1994 and 2002 and reported considerable variability in sexual behaviors over time. Many persons were not sexually active at all for months at a time; some continued to have multiple partners. Over one third of the cohort had one or more periods when they had engaged in unprotected sex with a partner who was HIV-negative or status unknown (unsafe sex) and one in five reported exchanging sex. Periods of unsafe sex alternated with periods of safer sex. Predictors of sexual risk varied by gender, and among men who had sex with men, and men sexually active with women only. Contextual factors such as partner relations, housing status, and receipt of HIV services were as important as individual attributes as predictors of unsafe sex and sex exchange. The variability observed in sexual risk behavior reported over time provides new insight into the importance of engaging persons living with HIV in ongoing prevention programs.

HIV-Positive Men Sexually Active with Women: Sexual Behaviors and Sexual Risks

“…The movement into and out of periods of unsafe behavior is also apparent when we examine rates over time of unsafe sex with a woman partner for the continuing cohort of MSW who were interviewed all eight or seven of eight times from Wave 1 to Wave 8 (2002). Rates of unsafe sex for this subset of long term participants (n = 89) were 18% at baseline (1994), fluctuated up and down during the late 1990s (11, 15, 14, and 9% ), with a dip to 5% at Wave 6 (1999), followed by an increase to 10% at Wave 7(2000Wave 7( -2001 and again to 13% at Wave 8 (2002) (data not shown, see also Aidala et al 41 ).…”

Intentional Abstinence Among Homeless and Unstably Housed Persons Living with HIV/AIDS

“…Other studies suggest that periods of sexual abstinence may be interspersed between other periods of sexual activity for some HIV-positive persons (e.g., Aidala et al 2006). These results, therefore, are not likely to represent life-long decisions in all, or even most, cases.…”

“…In contrast, a US national probability sample of PLWHA found that over 30% were sexually abstinent in the prior 6 months and nearly half of those reported that this was by choice (Bogart et al 2006). In a large New York City-based cohort, Aidala et al (2006) found that 58% of HIV-positive men and 65% of HIV-positive women reported that they were not sexually active for at least one 6-month period during the 10-year study. Other studies in the US have found rates of 6-month abstinence between 31% and 38% in HIV-positive samples (Reilly and Woo 2001;Wight et al 2000).…”

Residential Trajectory and HIV High-Risk Behaviors among Montréal Street Youth—A Reciprocal Relationship

“…Indeed, such living situations are likely to obstruct the development of trust relationships and positive linkages, which increases the risks of chronicization and maintains homelessness among street-involved youth. 45 Building on others' work, 22,23,25,55,56 the present study longitudinally examined the occurrence of a variety of HIV risk behaviors in relation to changes in housing situation among street-involved youths. A major strength of this approach, based on mixed-effects regression, is that both risk behaviors and housing situations were allowed to vary not only across study participants but also among them, which controlled for unmeasured potential individual confounders.…”