The study compares the prevalence of high-risk sexual behaviors in HIV-positive people aware of their serostatus (HIV+ aware) with the prevalence of such behaviors in HIV-positive people unaware of their serostatus (HIV+ unaware) in the United States and discusses the implications for HIV prevention programs. CDC estimates that of the 850,000-900,000 U.S. people living with HIV, approximately 250,000 are not aware of their status. "Little is known about the relative difference between these 2 groups in exposing uninfected sex partners to HIV. A better understanding of this relative difference can help to guide public health strategies and allocation of resources to fight the HIV/AIDS epidemic in the United States," the authors wrote.

The researchers conducted a meta-analysis on 11 independent findings: six findings comparing HIV+ aware patients with independent groups of HIV+ unaware patients (between-group comparisons), and 5 findings comparing 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 specific recall periods.

The analysis integrating all 11 findings indicated that the prevalence of UAV with any partner was on average 53 percent lower (95 percent confidence interval [CI]: 45 percent-60 percent) in HIV+ aware patients compared to HIV+ unaware patients. After adjusting the data to focus on UAV with partners who were not already HIV+, the researchers found a 68 percent reduction (95 percent CI: 59 percent-76 percent).

"In our analysis, the between-group and within-subject comparisons demonstrated significant reductions in self-reported UAV, although the reduction was higher in the between-group design," the authors found. The findings for men and women were highly similar.

"The prevalence of high-risk sexual behavior is reduced substantially after people become aware they are HIV+," the researchers concluded. "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."

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