Posted by Condom Depot on 02/21/2008
Approximately one-fifth of HIV-positive patients report never using condoms with regular or casual partners in a study conducted in New York and published in the February edition of AIDS Patient Care and STDs. Inconsistent use of condoms was associated with the presence of symptoms of depression, and most of the patients reporting unprotected sex had a detectable viral load.
Approximately one-fifth of HIV-positive patients report never using condoms with regular or casual partners in a study conducted in New York and published in the February edition of AIDS Patient Care and STDs. Inconsistent use of condoms was associated with the presence of symptoms of depression, and most of the patients reporting unprotected sex had a detectable viral load.
Although the investigators found no link between use of antiretroviral treatment and inconsistent or non-existent condom use in their multivariate analysis, they did find that patients who reported poor adherence to antiretroviral therapy were more likely to never or inconsistently use condoms.
Patients in the study were asked about their sexual behaviour and adherence using an audio computer-assisted self-interview and the results of this interview were made available to their doctors. The investigators suggest that these interviews could be used to identify ?a core group of nonadherent patients who do not consistently use condoms, and then deliver targeted intensive psychosocial services and prevention interventions to them.?
Thanks to the success of antiretroviral therapy people with HIV can live, longer, healthier lives. This good health means that individuals with HIV are likely to remain sexually active. Therefore HIV prevention efforts are being focused on people with diagnosed HIV infection and in 2003 the US Centers for Disease Control and Prevention announced an initiative to screen for sexual risk behaviour during HIV clinic appointments.
Investigators wanted to see if audio computer assisted interviews were a successful means of obtaining information about issues including sexual risk behaviour, adherence to antiretroviral therapy, and the presence of depressive symptoms.
A total of 198 patients at two HIV clinics with a predominately Latino population were recruited to the study in 2004. The patients were told that their answers during the computer-assisted interview would be provided to their HIV doctor.
Three quarters of the patients were Latino, 36% were gay/men who have sex with men, and 25% were women.
In the four weeks before the study, 65% reported being sexually active, with 24% reporting a regular partner only, 5% a casual partner only and 35% both a regular and a casual partner.
Of the patients who reported sex with a regular partner, 34% said they didn?t always use condoms and 18% said they never used condoms. Of the patients who said they had had sex with a casual partner, 26% reported not using condoms every time and 15% said they never used condoms. Overall 35% of sexually active individuals reported inconsistent condom use and 19% reported never using condoms.
Women were more likely than men to report never using condoms (32% vs, 15%, p = 0.047), and heterosexuals were more likely than gay men to report not using a condom every time with a regular partner (p = 0.04).
Taking antiretroviral therapy was associated with inconsistent condom use with regular partners in univariate analysis (p= 0.05). But this association disappeared in multivariate analysis that adjusted for age, race, gender and HIV transmission category. In multivariate analysis, the only factors significantly associated with not using condoms were self-reported depression (p = 0.03) and self-reported poor adherence to antiretroviral therapy (p = 0.02).
Of the patients who reported never using condoms with regular partners, 76% had a viral load above 400 copies/ml. All the patients who reported never using condoms with casual partners had a viral load above 400 copies/ml.
?We found that almost one fifth of those who had been sexually active in the past four weeks reported never using condoms with their regular or casual sex partners. Over one third of these patients reported not using condoms every time?, comment the investigators.
?Most patients with recent HIV RNA results who reported unprotected sex?had detectable HIV RNA?, the researchers observe, adding, ?the fact that a substantial number of patients with detectable HIV RNA are practicing unprotected sex is a serious concern.?
The investigators acknowledge that their study had some limitations, including the lack of diversity in the population. Nor were the investigators able to say if patients were having unprotected sex with partners of the same HIV status, or if men were adopting ?strategic positioning? (assuming the receptive role with men who were HIV-negative or of unknown HIV infection status).
SOURCE: Michael Carter, aidsmap.com
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