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Sexual risk behaviour and viral suppression among HIV-infected adults receiving medical care in the United States

Mattson, Christine L.a; Freedman, Marka; Fagan, Jennifer L.a; Frazier, Emma L.a; Beer, Lindaa; Huang, Pingb; Valverde, Eduardo E.c; Johnson, Christophera; Sanders, Catherinea; McNaghten, A.D.d; Sullivan, Patrickd; Lansky, Amya; Mermin, Jonathane; Heffelfinger, Jamesf; Skarbinski, Jaceka; for the Medical Monitoring Project

doi: 10.1097/QAD.0000000000000273
Epidemiology and Social

Objective: To describe the prevalence and association of sexual risk behaviours and viral suppression among HIV-infected adults in the United States.

Design: Cross-sectional analysis of weighted data from a probability sample of HIV-infected adults receiving outpatient medical care. The facility and patient response rates were 76 and 51%, respectively.

Methods: We analysed 2009 interview and medical record data. Sexual behaviours were self-reported in the past 12 months. Viral suppression was defined as all viral load measurements in the medical record during the past 12 months less than 200 copies/ml.

Results: An estimated 98 022 (24%) HIV-infected adults engaged in unprotected vaginal or anal sex; 50 953 (12%) engaged in unprotected vaginal or anal sex with at least one partner of negative or unknown HIV status; 23 933 (6%) did so while not virally suppressed. Persons who were virally suppressed were less likely than persons who were not suppressed to engage in vaginal or anal sex [prevalence ratio, 0.88; 95% confidence interval (CI), 0.82–0.93]; unprotected vaginal or anal sex (prevalence ratio, 0.85; 95% CI, 0.73–0.98); and unprotected vaginal or anal sex with a partner of negative or unknown HIV status (prevalence ratio, 0.79; 95% CI, 0.64–0.99).

Conclusion: The majority of HIV-infected adults receiving medical care in the U.S. did not engage in sexual risk behaviours that have the potential to transmit HIV, and of the 12% who did, approximately half were not virally suppressed. Persons who were virally suppressed were less likely than persons who were not suppressed to engage in sexual risk behaviours.

aDivision of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC)

bICF International, Inc, assigned full-time to the Division of HIV/AIDS Prevention, CDC

cDivision of Global HIV/AIDS, Center for Global Health, CDC

dEmory University

eNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC

fDivision of Global Disease Detection and Emergency Response, Center for Global Health, CDC, Atlanta, Georgia, USA.

Correspondence to Christine L. Mattson, PhD, CDC/Division of HIV/AIDS Prevention, 1600 Clifton Road NE, MS E-46, Atlanta, GA 30329, USA. E-mail: CMattson@cdc.gov

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Received December 3, 2013

Accepted February 25, 2014

© 2014 Lippincott Williams & Wilkins, Inc.