There are many effective, albeit expensive, intervention programs aimed at encouraging HIV-positive people to practice less risky behavior. But a new UCLA AIDS Institute study has found that self-monitoring by these patients is not only an effective strategy but is inexpensive and easy to implement as well.
By simply having patients answer a series of questions about their sexual behavior while waiting for regularly scheduled medical examinations, researchers found that people living with HIV took steps to change their behavior. The study is published in the July issue of the journal AIDS Care.
The questions brought up issues patients often had not considered, said lead author Marguerita Lightfoot, associate research psychologist at the Semel Institute for Neuroscience and Human Behavior at UCLA.
"In other studies, we often heard participants say, 'Oh, I never really thought about my behavior like that' when they completed study assessments," she said. "It appeared that by completing the self-assessments, people reflected on their own behavior and changed their behavior. It's very easy to implement and very cost effective."
The researchers surveyed 365 people living with HIV recruited from community medical clinics and health maintenance organizations. General requirements were that they be at least 18 years old, speak English, provide written informed consent, be free of severe neuropsychological impairments and psychosis, and not be involved in any other HIV behavioral intervention study.
Participants ranged in age from 19 to 69, with a median age of 41. Ninety-two percent were male, 70 percent were gay and 13 percent were bisexual. More than half were ethnic minorities, with African Americans accounting for 21 percent, Latinos 31 percent and other non-whites 7 percent. Eighty-eight percent were high school graduates, and 62 percent had completed at least one year of college. Seventy-seven percent received services from a non-HMO clinic.
While waiting for regularly scheduled examinations, participants were taken to a private room where they answered questions about their sexual behavior on laptop computers set up for that purpose. Questions addressed the number of participants' sexual partners, the HIV status of each partner and the number of sexual acts performed with them, and the number of times that condoms were used.
Some of the study participants completed more than four self-assessments.
Researchers found that the more self-assessments the patients completed, the higher the odds were that they would use condoms when having sex with HIV-negative partners or partners whose HIV status was unknown. Researchers also found that sexual activity tended to decrease over time as the number of self-assessments increased.
Also, as patients completed more assessments, they became increasingly aware of their risk of contracting other sexually transmitted diseases and their negative feelings about changing risky sexual behavior decreased. But neither the number of sex partners nor the fraction of protected acts with all partners showed any significant changes over time with increases in the number of self-assessments.
"Consequently, it appears that allowing PLH (people living with HIV) to reflect on their sexual behavior influences their subsequent decisions regarding sexual behavior," the researchers wrote. "It is likely that by having the patients acknowledge and report, in a nonconfrontive and nonjudgmental manner, those behaviors that could result in transmission of HIV, their motivation to reduce HIV-transmission-related behavior increased and their attitudes became more conducive to reducing risk behaviors.
"Consequently," they continued, "self-assessments appear to be a promising avenue for promoting behavior change in a setting which PLH regularly interface."
Other researchers on the study included Mary Jane Rotheram-Borus, Scott Comulada, Cameron Gundersen and Vanessa Reddy, all of UCLA.
A grant from the University of California's Universitywide AIDS Research Program to the UCLA Center for AIDS Research and Education and Lightfoot funded the study.
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