Sexual risk behavior and behavior change among newly diagnosed persons with HIV: The impact of enhanced outreach interventions among hard-to-reach populations

Background: The CDC notes that a comprehensive HIV prevention strategy includes knowledge of HIV status, counseling to reduce high-risk behavior, and referral for appropriate care. There is some literature to support that newly diagnosed persons living with HIV/AIDS (PLWHA) who undergo HIV counseling reduce risk behaviors, but it is unclear what techniques are most effective and whether behavior is sustained over time.

Methods: Participants from ten sites across the US were enrolled in outreach interventions designed to engage and retain PLWHA in care. Programs provided outreach, advocacy, HIV education/risk reduction counseling and linkage-to-care. 116 participants were diagnosed with HIV for < six months. Information on whether these individuals had unprotected sex in the last 6 months was collected at baseline, 6 and 12-month follow-up. We used generalized estimating equations (GEE) to examine changes in sexual risk behavior over time among the sample. GEE was used to account for potential clustering of outcomes by site and for repeated measures.

Results: The proportion of newly diagnosed individuals reporting unprotected sex after 6 and 12 months of intervention was reduced significantly compared to baseline. Adjusted odds ratio (AOR) at 6 months= .24, 95% CI = (.17, .32), p< .0001, AOR at 12 months = .21, 95% CI = (.13, .36), p<. 0001.

Conclusions: Substantial risk exists for secondary HIV transmission after seroconversion and there is little information on how behavior changes can be sustained over time. This study demonstrates that enhanced outreach to newly diagnosed individuals can be effective in reducing risk behaviors.