Studies suggest that approximately 30-45% of HIV-infected people continue to engage in some unprotected sexual activities. The perception that HIV-infection is now """"""""manageable"""""""" appears to increase the likelihood that HIV-infected persons will practice risky sexual behaviors. However, many patients have difficulty managing their illness with medication and people who adhere less to ART engage in more risky sex than others. When patients do not take all of their ART, their viral load often increases and they can develop resistant virus. Viral load level is the primary predictor of HIV transmission. Thus, people who are less adherent are more likely to transmit virus that may be resistant. Therefore, interventions to reduce the risky sexual behavior of persons with HIV, particularly those who are viremic are critically needed to slow the spread of HIV infection. To date, little research has demonstrated interventions that successfully reduced the risky sexual behaviors of HIV-infected individuals. In earlier work, the researchers in this proposal developed a multi-component audiotape/workbook-enhanced motivational interviewing tool to help persons with HIV improve their ART adherence and then adapted it to increase safer sex practices. In a collaborative effort between behavioral researchers and clinical virologists at the UNC Schools of Medicine, Public Health, Social Work and Dentistry, based on expertise in developing administering Motivational Interviews to persons with HIV, these researchers propose to use a theory-driven, Motivational Interviewing-based tool to enhance the safer sexual practices in a two-arm, randomized, controlled trial. The trial will be conducted among 490 viremic, HIV-infected individuals at a large Infectious Diseases Clinic, collecting self-reported sexual behaviors and urine assays for sexually transmitted infections at 3, 6 and 9 months. The study will also assess the relationship between risky sexual behaviors and adherence among this group of patients. The long term goals of this project are to produce and test better methods to reduce the spread of HIV.
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