Regular Testing and Counseling Lower Sexual Infection Rate in Gays With HIV

What the Results Mean for You

This study found that the rate of new sexually transmitted infections (STIs) fell by half in the year after HIV-positive gay and bisexual men began getting tested for STIs every 6 months and started a program aimed to help them reduce risky sexual behavior. The rate of new anal or rectal STIs fell by almost 60%.

Nearly 90% of the new STIs detected during this study caused no signs or symptoms and did not make these men feel sick. If these men had not been tested for STIs every 6 months, these STIs would not have been detected. Treatment of STIs like gonorrhea, chlamydia, and syphilis is usually very simple. But if these infections are not treated, they can cause serious health problems. In addition, the bacteria that can gonorrhea, chlamydia, or syphilis can be passed on to a sex partner.

The Centers for Disease Control and Prevention (CDC) recommends regular STI testing for sexually active people.⁴ How often you get tested depends on how much sex you have and what risks you take when having sex. Gay and bisexual men who have several sex partners, who don't know their sex partners personally, or who have sex while drinking alcohol or taking drugs should probably get tested for STIs every 3 to 6 months.

Regular STI testing can help lower the rate of new infections by reminding people about avoiding STI risks. Because having an STI raises the risk of picking up other STIs, detecting hidden STIs and treating them could lower the STI rate. Regular testing also reminds HIV providers to counsel their patients about avoiding STIs. Table 1 lists other advice on avoiding STIs.

Because of the way this study was designed, the researchers could not figure whether regular STI testing or STI risk counseling -- or both -- explain the falling STI rate in the men studied. They suggest that both twice-yearly STI testing and risk-reduction counseling contributed to the falling STI rate and that these two strategies should be combined.

A previous study of the Partnership for Health program in 585 HIV-positive Californians found that it lowered the rate of condom-free anal or vaginal sex by 38% in people with two or more sex partners.³ Another 13-center study found that brief prevention counseling by HIV providers lowers rates of unprotected vaginal or anal sex with HIV-negative partners or partners with an unknown HIV status.⁵

It is also hard to explain why the study did not find a drop in risky sex behavior even though the new STI rate fell. The overall rate of sex without a condom remained the same from the first study visit to the second study visit 12 months later. It could be that some men did start practicing less risky sex recently, but that the survey they completed did not pick up that change.

Although the rate of anal sex without condoms with HIV-positive partners rose slightly during the 12-month study period, the rate of this kind of sex with HIV-negative partners did not change. Those findings suggest that some men may have adopted the strategy called serosorting -- having sex only with partners of the same HIV status (positives only with positives and negatives only with negatives). Although serosorting may lower the risk of picking up HIV infection, it does not cut the risk of picking up a new STI.

Wearing condoms during anal sex lowers the risk of getting infected with HIV and with other sexually transmitted infections. Consistent condom use is the surest and easiest way to prevent the spread of HIV and other STIs during sex.

References

1. Patel P, Bush T, Mayer K, et al. Routine brief risk-reduction counseling with biannual STD testing reduces STD incidence among HIV-infected men who have sex with men in care. Sex Transm Dis. 2012;39:470-474.
2. Centers for Disease Control and Prevention. Partnership for Health: a brief safer-sex intervention in HIV clinics.
3. Richardson JL, Milam J, McCutchan A, et al. Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment. AIDS. 2004;18:1179-1186.
4. Centers for Disease Control and Prevention. Sexually Transmitted Disease Guidelines, 2010. MMWR Recomm Rep. 2010;59(RR12);1-110.
5. Myers JJ, Shade SB, Rose CD, et al. Interventions delivered in clinical settings are effective in reducing risk of HIV transmission among people living with HIV: Results from the Health Resources and Services Administration (HRSA)'s special projects of national significance initiative. AIDS Behav. 2010;14:483-492.