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

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.