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The Need for Intervention

Neil S. Wenger, MD, MPH; Françoise S. Kusseling, MOB; Keith Beck, MD; Martin F. Shapiro, MD, PhD

Arch Intern Med. 1994;154(16):1849-1854.

Abstract
Background
Public health efforts to stop the spread of the human immunodeficiency virus (HIV) emphasize behavior change among all persons at risk of infection. Yet efficient physician-based intervention might be targeted toward persons infected with HIV. To evaluate the need for intervention among HIV-infected persons attending a continuity clinic, we determined the prevalence of behaviors risky for new transmission of HIV and the characteristics of HIV-infected individuals participating in such behavior.

Methods
Cross-sectional structured survey of 227 HIV-infected patients attending an urban HIV continuity-of-care clinic.

Results
Nine percent of the subjects had vaginal, anal, or oral sex without a condom with an HIV-negative last sex partner (24% of whom were unaware that the subject was HIV infected) and an additional 13% with an HIV-status-unknown last sex partner (41% were unaware that the subject was HIV infected). Subjects used a condom for intercourse more often with a partner they knew to be HIV negative than HIV-status-unknown or HIV-positive (84% vs 59% vs 51%). Subjects with more lifetime male sexual partners were more likely to have had sex without a condom with an HIV-negative or HIV-status-unknown partner.

Conclusion
The HIV-infected individuals in this clinic setting participate in a substantial amount of sexual behavior placing others at risk of new HIV infection. Physicians must address such behaviors, and programs specifically aimed at reducing such behavior should be a public health priority.

(Arch Intern Med. 1994;154:1849-1854)

Author Affiliations
From the Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California—Los Angeles (Drs Wenger and Shapiro and Ms Kusseling) and the Division of Allergy and Clinical Immunology, Department of Medicine, Harbor/UCLA Medical Center, Los Angeles (Dr Beck).

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