Promoting Safer Sex 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无保护的性活动。认为艾滋病毒感染现在是“可控制的”的看法似乎增加了艾滋病毒感染者从事危险性行为的可能性。然而，许多患者很难用药物治疗他们的疾病，而那些坚持ART的人比其他人更容易发生危险的性行为。当患者没有服用所有的抗逆转录病毒药物时，他们的病毒载量通常会增加，并且可能会产生耐药病毒。病毒载量水平是HIV传播的主要预测因子。因此，粘附性较低的人更有可能传播可能具有耐药性的病毒。因此，迫切需要采取干预措施，减少艾滋病毒感染者，特别是病毒血症者的危险性行为，以减缓艾滋病毒感染的蔓延。迄今为止，很少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，这项提案中的研究人员开发了一种多成分录音带/工作簿增强的动机访谈工具，以帮助艾滋病毒感染者提高他们的抗逆转录病毒治疗依从性，然后对其进行调整，以增加更安全的性行为。在行为研究人员和临床病毒学家之间的合作努力中，在医学，公共卫生，社会工作和牙科学院，基于开发管理动机访谈的专业知识，这些研究人员建议使用理论驱动，动机访谈为基础的工具，以提高安全的性行为在双臂，随机，对照试验。该试验将在一家大型传染病诊所的490名病毒血症、艾滋病毒感染者中进行，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检测。该研究还将评估这组患者中危险性行为和依从性之间的关系。该项目的长期目标是制定和测试更好的方法，以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.