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Meta-Analysis of High-Risk Sexual Behavior in Persons Aware and Unaware They are Infected With HIV in the United States: Implications for HIV Prevention Programs

Marks, Gary; Crepaz, Nicole PhD; Senterfitt, J Walton PhD; Janssen, Robert S MD

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1st, 2005 - Volume 39 - Issue 4 - p 446-453
doi: 10.1097/01.qai.0000151079.33935.79
Epidemiology and Social Science

Objectives: To compare the prevalence of high-risk sexual behaviors in HIV+ persons aware of their serostatus with that in HIV+ persons unaware of their status in the United States and to discuss implications for HIV prevention programs.

Methods: A meta-analysis was conducted on 11 independent findings. Six findings compared HIV+ aware persons with independent groups of HIV+ unaware persons (between-group comparisons), and 5 findings compared seroconverting individuals before and after being notified of their HIV+ status (within-subject comparisons). Outcomes were self-reported unprotected anal or vaginal intercourse (UAV) during specified recall periods.

Results: The analysis integrating all 11 findings indicated that the prevalence of UAV with any partner was an average of 53% (95% confidence interval [CI]: 45%-60%) lower in HIV+ persons aware of their status relative to HIV+ persons unaware of their status. There was a 68% reduction (95% CI: 59%-76%) after adjusting the data of the primary studies to focus on UAV with partners who were not already HIV+. The reductions were larger in between-group comparisons than in within-subject comparisons. Findings for men and women were highly similar.

Conclusions: The prevalence of high-risk sexual behavior is reduced substantially after people become aware they are HIV+. Increased emphasis on HIV testing and counseling is needed to reduce exposure to HIV from persons unaware they are infected. Ongoing prevention services are needed for persons who know they are HIV+ and continue to engage in high-risk behavior.

From the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA.

Received for publication June 9, 2004; accepted November 4, 2004.

Reprints: Gary Marks, Division of HIV/AIDS Prevention, CDC, 1600 Clifton Road, Mailstop E-45, Atlanta, GA 30333 (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.