A9c Using STI Data to Identify and Reduce High-Risk Sexual Behavior in HIV+ Individuals

Tuesday, March 9, 2010: 10:45 AM
Grand Ballroom C (M4) (Omni Hotel)
Christina Nelson, MD1, Stefan Sillau, MS2, Elaine Daniloff, MPH3, Mel Mattson, BS3 and Ralph Wilmoth, MPH, MPA3, 1Department of Preventive Medicine, Colorado School of Public Health, Aurora, CO, 2Department of Biostatistics and Informatics, School of Public Health, University of Colorado at Denver, Anschutz Medical Campus, Aurora, CO, 3Disease Control and Environmental Epidemiology, Colorado Department of Public Health and Environment, Denver, CO

Background: In Colorado, an HIV+ person who knowingly exposes others to infection is considered a public health risk. The Recalcitrant Exposure Review (RER) program at the Colorado Department of Public Health and Environment identifies HIV+ persons who contract an STI or are named as non-disclosing by a sexual partner and uses public health authority to order counseling and/or other restrictions to prevent the spread of HIV. Research has demonstrated that behavioral interventions to promote serostatus disclosure among HIV+ persons are beneficial, however there is little published data on the effectiveness of legal interventions.

Objectives: To determine the effectiveness of public health law at reducing high-risk sexual behavior in HIV+ persons.

Methods: The primary measure in this study was rate of STI, a strong indicator of unprotected sexual activity. Records of all HIV+ persons in Colorado who were diagnosed with an STI (gonorrhea, chlamydia, or syphilis) from 2002-2008 were extracted and analyzed. The STI rate in HIV+ persons in Colorado was calculated for 2002 (prior to the RER program) and compared to 2008. Additionally, the average STI rate before a person entered the RER program was compared to the average STI rate one year after entering the program.

Results: The STI rate in the HIV+ population in 2008 was 0.192 times (80.8% lower than) the STI rate in 2002, prior to implementation of the RER program. In contrast, the overall statewide STI rate increased 11.9% from 2002 to 2008. The average STI rate in persons after one year in the RER program was 0.7072 times (29.3% lower than) the rate of STI before entering the program.

Conclusions: Enforcement of HIV disclosure laws can reduce high-risk sexual behavior in HIV+ persons.

Implications for Programs, Policy, and/or Research: Policy makers should consider implementing public health legislation to discourage high-risk sexual behavior by HIV+ persons.