of HIV-positive people in the United States are not receiving prevention
counselling as part of their routine care, results of a study published in the
online edition of AIDS show.
“We found that
less than half our clinic-based sample reported receiving individual-level
HIV/STD prevention counseling from healthcare providers,” comment the authors.
“Exposure to individual-level prevention counseling from prevention program
workers and to small group interventions was even lower.” The investigators
believe their findings highlight “missed prevention opportunities”.
More than 1.1
million people are living with HIV in the US. Guidelines recommend that
HIV/sexual health risk reduction counselling should be incorporated into
routine HIV care. However, little is known about the proportion of patients in
care who receive such counselling.
the Medical Monitoring Project therefore used face-to-face interviews and
medical records to establish the percentage of people receiving care who received three
types of HIV/sexual health prevention intervention in 2009. The interventions
were: counselling provided by healthcare workers; individual-level counselling
provided by HIV prevention workers; participation in a small group HIV/sexual
health risk-reduction intervention. The investigators also explored the factors
associated with participation in such interventions.
A total of 4217 people from across the US participated in the study. Two-thirds were aged
between 35 and 54 years, 71% were men and 65% belonged to racial and ethnic
minorities. The majority – 65% – were subsisting on an annual income below
$20,000. Thirteen per cent reported unprotected sex with a partner who was
HIV negative or of unknown HIV status. A similar proportion reported diagnosis
with a sexually transmitted infection (STI) in the previous twelve months. Use
of stimulant drugs was reported by 11% of participants.
conversation in the past year with a healthcare worker about HIV/STI prevention
was reported by 44% of participants. Just under a third of participants (30%)
reported a conversation with a prevention programme worker and 16% told the
investigators they had participated in a small group intervention within the
previous twelve months.
Overall, 52% of
participants reported participating in any one of the three interventions.
Among participants who
reported unprotected sex in the past year that potentially involved a risk of
HIV transmission, only 61% received a risk-reduction intervention. A similar
percentage (63%) of participants diagnosed with a STI had one-to-one or group
lack of skill and embarrassment are offered by the investigators as possible
explanations for failure to provide the risk-reduction counselling recommended
minority ethnic/racial origin and reporting risky sex were all consistently
associated with receiving risk-reduction counselling.
investigators’ initial analysis, men who have sex with men (MSM) were shown to
be significantly less likely than other groups to have received a HIV/sexual
health risk-reduction intervention. However, this was no longer the case when
the authors controlled for income and race. “It is possible that white and
wealthier MSM may not be identified by program workers as being in need of
prevention counseling,” suggest the investigators. “They may also be more
likely than other MSM to receive care at facilities where those interventions
may not be readily available (e.g., private practice).”
conclude: “Levels of intervention exposure, particularly for individual-level
prevention-level counseling delivered by healthcare providers, are low, given
the fact that all of the participants in the sample are clinic patients, and,
thus, presumably should have an opportunity to receive provider counseling.”
They recommend that patients with high-risk behaviour should be “prioritized
for receipt of interventions with a goal to reach as close to 100% as possible”.