Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #108228

Katharine E. Stewart, PhD¹, Paul G. Greene, PhD¹, Dana Ross, PhD², Polly Kratt, PhD², Casey Balentine, BS², Patricia Lee, PhD³, and Yi Wang, MS⁴. (1) College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 820, Little Rock, AR 72205, (501) 526-6622, kestewart@uams.edu, (2) Division of Preventive Medicine, University of Alabama at Birmingham, MT644, 1530 3rd Ave S, Birmingham, AL 35294-4410, (3) Department of Health Behavior, University of Alabama at Birmingham, RPHB 227, 1530 3rd Ave S, Birmingham, AL 35294-0022, (4) Comprehensive Cancer Center, University of Alabama at Birmingham, LNB 1078, 1530 3rd Ave S, Birmingham, AL 35294-0001

Background: Poor adherence with antiretroviral therapy has been consistently associated with substance abuse. However, the association of adherence with unprotected sex is unclear. One hypothesis suggests adherent individuals may engage in additional preventive behaviors including sexual risk reduction. Alternatively, they may engage in riskier sex if they believe that adherence is potentially protective. This study examines associations among multiple risk behaviors in an HIV+ cohort. Methods: The SMAART study is a randomized behavioral trial examining theory-based counseling on adherence and viral load among HIV+ adults. Generalized estimating equations (GEE) examined the association of unprotected sex with demographics, substance use, adherence and viral load (VL). Results: Unprotected sex was not related to substance use (p<.98) or adherence (p<.87) in the study cohort. However, younger age was associated with unprotected sex (p<.01), and lower VL trended towards significance (p<.07). A mean adherence rate of 95% was found for those having unprotected sex and 90% for those who did not (p<.63). Mean VL was 61 for those having unprotected sex and 275 for those who did not (p<.07, two-tailed). Conclusions: Although risk behaviors were unrelated in this cohort, results raise concerns that adherence promotion interventions may inadvertently increase risk of HIV transmission or re-infection if patients with low VL are more likely to engage in unprotected sex. Patients perceived as “low risk” due to high adherence or undetectable VL may still benefit from sexual risk reduction messages, underscoring the importance of addressing multiple risk behaviors in the management of HIV disease.

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