Motivational and behavioural interventions needed to reduce sexual risk by people with HIV

There is a “paucity” of studies examining sexual risk reduction amongst individuals diagnosed with HIV, according to American researchers. In a meta-analysis published in the April 15^th edition of the Journal of Acquired Immune Deficiency Syndromes the investigators were only able to identify 15 randomised controlled trials examining interventions to increase condom use by people with HIV or reduce the number of their sexual partners. They contrast this to the “literally hundreds of studies conducted with uninfected populations.”

Interventions that provided motivational and skills components were the most successful, and the investigators noted that although studies suggested it was possible to increase condom use amongst people with HIV, it was harder to reduce numbers of sexual partners.

Thanks to potent antiretroviral therapy people with HIV can now expect to live long and healthy lives. This means that HIV-positive individuals will potentially be sexually active for decades and will have to make long-term changes to their sexual behaviour if they want to avoid the risk of transmitting HIV to others.

Some studies have found that being diagnosed with HIV increases the use of condoms and that the majority of HIV-positive individuals do not expose others to the risk of HIV infection during sex. Risk-reduction strategies have been targeted at individuals with HIV with mixed results and investigators from the United States therefore conducted a review of all the available randomised controlled trials examining efforts to increase condom use or reduce the number of sexual partners by individuals with HIV.

They identified a total of 15 such studies between 1993 and 2004; eleven of these only included individuals with HIV, whilst the remaining four mainly comprised HIV-negative individuals but included some people diagnosed with HIV. The studies involved 3,234 individuals, the majority of whom (64%) were male, approximately half were African American and the average age was 35 years. All but one of the studies was conducted in the US, seven comprised populations of gay men and injecting drug users were included in twelve studies.

Initial follow-up occurred a median of 19 weeks after the HIV risk reduction intervention. Information about HIV was provided in all the studies, with 13 also providing a motivational component such as social support and twelve behavioural skills training, for example about condom use.

Interventions were shown to lead to a significant increase in the level of condom use (p < 0.001) for anal, oral or vaginal sex. However, there was no evidence that either motivational or behavioural interventions had any effect on the number of sexual partners HIV-positive individuals had.

The investigators then looked at the features associated with the interventions that increased condom use. They found that interventions were more successful if they involved younger rather than older individuals. They also found that the number of gay men involved in an intervention had an effect on how successful it was. Interventions with the fewest gay men were the most successful and interventions that included a population entirely comprising gay men did not significantly increase condom use. The investigators also established that interventions needed to include informational, motivational and behavioural elements in order to increase condom use.

Commenting on their findings, the investigators note that even though their meta-analysis showed that interventions including gay men were less successful at increasing condom use, there is good evidence that “interventions that have a strong skills training component” can achieve “notable reductions” in sexual risk taking by gay men.

The investigators hypothesise that interventions are more successful with younger populations because “older samples may have longer duration partnerships…a factor that is known to increase resistance to change.”