A programme of structured counselling sessions reduced reported rates of risky sex in a population of HIV-positive men who have sex with men, according to a study published in the December 1st edition of the Journal of Acquired Immune Deficiency Syndromes. The study was conducted in four US cities, the researchers also finding that the counselling, which was based on cognitive behavioural therapy, maintained the reported rates of “serosorting” – the selection of sexual partners who were also HIV-positive.
Individuals with diagnosed HIV infection are a target for tailored HIV prevention interventions. The Healthy Living Project is an intervention aimed to support HIV-positive people to cope with the stresses of living with the virus, particularly regarding HIV transmission.
The Healthy Living Project involved 15 90 minute one-to-one counselling sessions, divided into three modules. The first module focused on stress, coping, adjustment, the second on safer behaviours, and the third on health behaviours.
Recruitment to the study took place between 2000 and 2004 in four US cities. All the participants were HIV-positive adults who had reported unprotected sex in the previous three months with a partner who was HIV-negative or of unknown HIV status, or an HIV-positive partner other than their primary partner.
A total of 616 men who have sex with men were recruited to the study. They were randomised to either receive the counselling sessions immediately, or for these to be provided at a later date. The investigators then compared rates of reported risk behaviour between the two groups. The study lasted 25 months, and data on sexual behaviour were collected every five months.
At baseline, the mean number of acts of anal or vaginal sex with an HIV-negative partner or a partner of unknown HIV status in the previous three months was 15 with a mean of nine of these being unprotected.
There was a significant reduction in the number of risky sex acts during the course of the study for both those who received the counselling, and individuals in the control arm. However, from months five to 20, individuals who received the counselling reported significantly episodes of unprotected sex that could have involved a risk of HIV transmission than those in the control arm (p = 0.02). There was no difference at month 25.
On entry to the study, approximately 40% of individuals reported having sex partners who were also HIV-positive. This figure remained unchanged amongst the men who received the counselling, but fell amongst men in the control arms, the difference being significant at the month five (p
The investigators believe that their results demonstrate that “a cognitive-behavioral intervention as part of prevention case management may be efficacious in reducing risk of HIV transmission”. The investigators note that the second module of the intervention “focused explicitly on building communication skills for negotiating safer sex and HIV serostatus disclosure decisions.” They believe that it is “plausible that subsequent reductions in HIV transmission risk and enhanced serosorting among men who have sex with men in the intervention are due to the influence of specific skills provided during this module.”
However, they note that there were significant reductions in reported risk behaviour amongst men in both the counselling and control arms. They speculate “having participants reflect on the number on the numbers and HIV serostatus of their partners may, in itself, constitute a prevention intervention” and account for the results seen in the control arm.
An adaptation of the Healthy Living Project could, the investigators suggest, be delivered by specialists as part of existing HIV out-patient services. After the initial sessions, occasional boosters could be offered.
Morin, S.F. et al. A behavioral intervention reduces HIV transmission risk by promoting sustained serosorting practices among HIV-infected men who have sex with men. J Acquir Immune Defic Syndr. 49: 544-51, 2008.