Prevention programmes during HIV clinic visits cut risky sex

Prevention programmes delivered at HIV clinics can reduce risky sexual behaviour, a US study published in the online edition of AIDS and Behavior suggests.

Patients who received prevention information from healthcare professionals during their routine HIV clinic appointments reported a significant decrease in risky sex after a year, compared to those who received only standard care.

In addition, people who were provided with safer sex information by prevention specialists at their HIV clinic had a short-term reduction in risky sex.

“HIV prevention…programs delivered by either medical care providers or HIV prevention specialists are effective in reducing sexual risk behavior among patients in the clinical setting,” comment the investigators.

Earlier research has suggested that HIV clinics can be an appropriate location in which to provide health promotion and safer sex messages.

US investigators wished to determine the effectiveness of various types of HIV prevention programmes delivered in the clinic.

They therefore designed a randomised, prospective study involving 3556 HIV-positive patients recruited at 13 sites across the US.

These individuals were randomised into four arms.

The first did not receive any form of enhanced HIV prevention during visits to their HIV clinic.

However, patients in the second arm were provided with HIV prevention information by a healthcare professional, whilst those in the third study arm participated in HIV prevention interventions which were delivered by a prevention specialist.

Finally, individuals in the fourth arm received prevention information from both specialists and clinical staff.

At baseline, and then after six and twelve months, the patients provided information about their sexual behaviour.

They were asked to state if they had had unprotected penetrative sex (anal or vaginal) with a partner who was HIV-negative or of unknown HIV infection status.

Most (70%) of the patients were male and aged over 40 (64%). Similar proportions of patients said that they were gay (44%) and heterosexual (45%), with 8% reporting that they were bisexual.

Just over three-quarters (77%) of patients were sexually active at baseline. Of these, 11% reported unprotected anal or vaginal sex with an HIV-negative partner in the previous six months, and 10% reported penetrative sex in that time period with a partner of unknown status.

Compared to patients who received the standard care, individuals who engaged with HIV prevention specialists were significantly less likely to report unprotected penetrative sex with an HIV-negative partner, or partner of unknown status after six months (OR = 0.58; 95% CI, 0.35 to 0.96, p < 0.04).

However, after twelve months, the difference between these two study arms had ceased to be significant (OR = 0.67; 95% CI, 0.39 to 1.14, p < 0.14).

Results for the patients who received their HIV prevention interventions from a medical professional were somewhat different.

After six months, these patients were just as likely as those receiving the standard care to report risky sex.

However, this had changed after twelve months, and a significant reduction in risky sexual behaviour amongst those receiving prevention information from medical professionals was apparent (OR = 0.55; 95% CI, 0.32 to 0.94, p < 0.03).

The greatest decreases in risky sex were seen amongst those who received interventions from both prevention specialists and HIV health professionals.

The investigators suggest that these results show that “behavioral interventions are most effective if they are delivered in ‘doses’ – such as at routine care visits”.

They conclude, “our results support increased calls for the integration of prevention into care settings…forthcoming papers describing the findings of qualitative [research] and the cost effectiveness of interventions will provide additional evidence for selection and implementation of prevention models.”