Promoting Safer Behavior Among Viremic HIV+Patients

描述(由申请人提供)： 研究表明，大约30%-45%的艾滋病毒感染者继续从事一些没有保护措施的性行为。认为艾滋病毒感染现在“可控”的看法似乎增加了艾滋病毒感染者实施危险性行为的可能性。然而，许多患者很难通过药物来管理他们的疾病，而不太坚持抗逆转录病毒治疗的人比其他人从事更危险的性行为。当患者没有接受所有的抗逆转录病毒治疗时，他们的病毒载量往往会增加，他们可能会产生抗药性病毒。病毒载量水平是艾滋病毒传播的主要预测因素。因此，粘附率较低的人更有可能传播可能具有抗药性的病毒。因此，迫切需要采取干预措施，减少艾滋病毒携带者，特别是病毒携带者的危险性行为，以减缓艾滋病毒感染的传播。到目前为止，几乎没有研究表明干预措施成功地减少了艾滋病毒感染者的危险性行为。在早期的工作中，该提案中的研究人员开发了一种多成分录音带/练习册增强的动机访谈工具，以帮助艾滋病毒携带者提高他们对艺术的坚持，然后对其进行调整，以增加更安全的性行为。在北卡罗来纳大学医学院、公共卫生、社会工作和牙科学院的行为研究人员和临床病毒学家之间的合作努力中，这些研究人员基于开发对艾滋病毒携带者进行动机访谈的专业知识，提议在一项双臂随机对照试验中使用一种基于理论驱动、动机访谈的工具来加强安全的性行为实践。这项试验将在一家大型传染病诊所的490名病毒携带者中进行，收集自我报告的性行为和3、6和9个月时的性传播感染尿液分析。这项研究还将评估这类患者中危险的性行为与依从性之间的关系。该项目的长期目标是开发和测试更好的方法来减少艾滋病毒的传播。

DESCRIPTION (provided by applicant): Studies suggest that approximately 30-45% of HIV-infected people continue to engage in some unprotected sexual activities. The perception that HIV-infection is now "manageable" appears to increase the likelihood that HIV-infected persons will practice risky sexual behaviors. However, many patients have difficulty managing their illness with medication and people who adhere less to ART engage in more risky sex than others. When patients do not take all of their ART, their viral load often increases and they can develop resistant virus. Viral load level is the primary predictor of HIV transmission. Thus, people who are less adherent are more likely to transmit virus that may be resistant. Therefore, interventions to reduce the risky sexual behavior of persons with HIV, particularly those who are viremic are critically needed to slow the spread of HIV infection. To date, little research has demonstrated interventions that successfully reduced the risky sexual behaviors of HIV-infected individuals. In earlier work, the researchers in this proposal developed a multi-component audiotape/workbook-enhanced motivational interviewing tool to help persons with HIV improve their ART adherence and then adapted it to increase safer sex practices. In a collaborative effort between behavioral researchers and clinical virologists at the UNC Schools of Medicine, Public Health, Social Work and Dentistry, based on expertise in developing administering Motivational Interviews to persons with HIV, these researchers propose to use a theory-driven, Motivational Interviewing-based tool to enhance the safer sexual practices in a two-arm, randomized, controlled trial. The trial will be conducted among 490 viremic, HIV-infected individuals at a large Infectious Diseases Clinic, collecting self-reported sexual behaviors and urine assays for sexually transmitted infections at 3, 6 and 9 months. The study will also assess the relationship between risky sexual behaviors and adherence among this group of patients. The long term goals of this project are to produce and test better methods to reduce the spread of HIV.