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Routine Brief Risk-Reduction Counseling With Biannual STD Testing Reduces STD Incidence Among HIV-Infected Men Who Have Sex With Men in Care

Patel, Pragna MD, MPH*; Bush, Tim BA*; Mayer, Kenneth MD; Milam, Joel PhD; Richardson, Jean DrPH; Hammer, John MD§; Henry, Keith MD; Overton, Turner MD‖,**; Conley, Lois MPH*; Marks, Gary PhD*; Brooks, John T. MD*; for the SUN Study Investigators

Sexually Transmitted Diseases: June 2012 - Volume 39 - Issue 6 - p 470–474
doi: 10.1097/OLQ.0b013e31824b3110
Original Study

Background: We evaluated whether routine biannual sexually transmitted disease (STD) testing coupled with brief risk-reduction counseling reduces STD incidence and high-risk behaviors.

Methods: The SUN study is a prospective observational HIV cohort study conducted in 4 US cities. At enrollment and every 6 months thereafter, participants completed a behavioral survey and were screened for STDs, and if diagnosed, were treated. Medical providers conducted brief risk-reduction counseling with all patients. Among men who have sex with men (MSM), we examined trends in STD incidence and rates of self-reported risk behaviors before and after exposure to the risk-reduction intervention. The “preintervention” visit was the study visit that was at least 6 months after enrollment STD screening and treatment and at which the participant was first exposed to the intervention. The “postintervention” visit was 12 months later.

Results: Among 216 MSM with complete STD and behavioral data, median age was 44.5 years; 77% were non-Hispanic white; 83% were on highly active antiretroviral treatment; 84% had an HIV RNA level <400 copies/mL and the median CD4 (cluster of differentiation 4) count was 511 cells/mm3. Twelve months after first exposure to the risk-reduction intervention, STD incidence declined from 8.8% to 4.2% (P = 0.041). Rates of unprotected receptive or insertive anal intercourse with HIV-positive partners increased (19% to 25%, P = 0.024), but did not change with HIV-negative partners or partners of unknown HIV status (24% to 22%, P = 0.590).

Conclusions: STD incidence declined significantly among HIV-infected MSM after implementing frequent, routine STD testing coupled with risk-reduction counseling. These findings support adoption of routine STD screening and risk-reduction counseling for HIV-infected MSM.

From the *Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA; Department of Medicine, Miriam Hospital and Warren Alpert School of Medicine at Brown University, Providence, RI and the Fenway Institute, Fenway Health, Boston, MA; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; §Denver Infectious Disease Consultants, Denver, CO; HIV Program, Hennepin County Medical Center, Minneapolis, MN; Department of Infectious Diseases, Washington University, St. Louis, MO; **and Department of Infectious Diseases, University of Alabama, Birmingham, AB

The authors thank all the SUN study participants.

The SUN Study Investigators are: John T. Brooks, Pragna Patel, Lois Conley, and Tim Bush, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, GA; Kathleen Wood, Rose Baker, and Cheryl Akridge, Cerner Corporation, Vienna, VA; John Hammer, Tara Kennedy, Barbara Widick and Billie Thomas, Denver Infectious Disease Consultants, Inc., Denver, CO; Ken Lichtenstein and Cheryl Stewart, National Jewish Medical and Research Center, Denver, CO; Keith Henry, Jason Baker, Rachel Prosser, Edie Gunderson, Miki Olson, and John Hall, Hennepin County Medical Center, Minneapolis, MN; Frank Rhame, Mark Olson, and Eve Austad, Abbott-Northwestern Hospital, Minneapolis, MN; Hal Martin, Meaghan Morton, and Cheri Murch, Park-Nicollet Institute, Minneapolis, MN; Charles Carpenter, Susan Cu-Uvin, Kenneth Mayer, Erna Milunka Kojic, Jennifer Florczyk, Sara Metzler, and Patricia D'Aiello, The Miriam Hospital, Providence, RI; and E. Turner Overton, Don Connor, Lisa Kessels, Mariea Snell, Sara Hubert, Dorothea Dedeaux-Turner, and Kenneth Griffie, WA University School of Medicine, St. Louis, MO.

Supported by Centers for Disease Control and Prevention contract numbers: 200–2002–00610, 200–2002–00611, 200–2002–00612, 200–2002–00613, 200–2007–23633, 200–2007–23634, 200–2007–23635, and 200–2007–23636.

These data were presented in part to the XVIII International AIDS Conference, July 18–23, 2010, Vienna, Austria.

The investigation followed the guidelines of the U.S. Department of Health and Human Services regarding protection of human subjects. The study protocol was approved and renewed annually by each participating institutions' ethical review board. All study participants provided written, informed consent.

The findings and conclusions from this review are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Conflicts of interest: T.O. has served as a consultant or on an advisory board for the following companies: Gilead, Bristol Myers Squibb, Glaxo-Smith-Kline, Tibotec, Merck, and Monogram Sciences.

Correspondence: Pragna Patel, MD, MPH, Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road, MS E-45, Atlanta, GA 30333. E-mail:

Received for publication October 3, 2011, and accepted December 28, 2011.

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