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Medication Adherence and Sexual Risk Behavior among HIV-Infected Adults: Implications for Transmission of Resistant Virus

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Abstract

As more people are living long-term with HIV there are growing concerns about specific behaviors that can affect both personal and the public health. This study examined the relationship between antiretroviral therapy (ART) adherence and sexual risk behavior and their association with psychosocial and health factors among a diverse sample of 2,849 HIV-infected adults. Only 8.5% of the sample reported both non-adherence and sexual risk. Individuals were 46% more likely to report one of these risk outcomes when the other one was present and the presence of both outcomes was associated with an increased likelihood of having a detectable viral load. A simultaneous polytomous regression analysis revealed complex relationships among a range of psychosocial variables and the two primary behavioral risk outcomes. There is a need for targeted interventions and integration of mental health and substance use services into primary HIV care settings.

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Acknowledgments

This research was funded by National Institute of Mental Health grants U10-MH57636, U10-MH57631, U10-MH57616, and U10-MH57615; and NIMH center grants P30-MH058107 (Mary Jane Rotheram-Borus, Ph.D., PI), P30-MH57226 (Jeffrey A. Kelly, Ph.D., PI), P30-MH43520 (Anke A. Ehrhardt, Ph.D., PI), and P30-MH062246 (Thomas J. Coates, Ph.D., PI).

The authors thank those at NIMH: Ellen Stover, Ph.D., and Willo Pequegnat, Ph.D., for their technical assistance in developing the study and Christopher M. Gordon, Ph.D., and Dianne Rausch, Ph.D., for their support of this research. Gratitude is also given to Susan Tross, Ph.D. and Gary Dowsett, Ph.D. for methodological guidance; to Brian Dodge, Ph.D. for reading previous versions of this manuscript, to the assessors in each city who conducted the interviews, to our clinic and community based organization collaborators, to all other support staff involved in the project, and to the men and women who participated in the interviews.

This study was conducted by the NIMH Healthy Living Trial Group. Research Steering Committee (site principal investigators and NIMH staff collaborator): Margaret A. Chesney, Ph.D.1, Anke A. Ehrhardt, Ph.D.2, Jeffrey A. Kelly, Ph.D.3, Willo Pequegnat, Ph.D.4, Mary Jane Rotheram-Borus, Ph.D.5 Collaborating Scientists, Co-Principal Investigators, and Investigators: Eric G. Benotsch, Ph.D.3, Michael J. Brondino, Ph.D.3, Sheryl L. Catz, Ph.D.3, Edwin D. Charlebois, Ph.D., M.P.H.1, Don C. DesJarlais, Ph.D.6, Naihua Duan, Ph.D.5, Theresa M. Exner, Ph.D.2, Rise B. Goldstein, Ph.D., M.P.H.5, Cheryl Gore-Felton, Ph.D.3, A. Elizabeth Hirky, Ph.D.2, Mallory O. Johnson, Ph.D.1, Robert M. Kertzner, M.D.2, Sheri B. Kirshenbaum, Ph.D.2, Lauren E. Kittel, Psy.D.2, Robert Klitzman, M.D.2, Martha Lee, Ph.D.5, Bruce Levin, Ph.D.2, Marguerita Lightfoot, Ph.D.5, Stephen F. Morin, Ph.D.1, Steven D. Pinkerton, Ph.D.3, Robert H. Remien, Ph.D.2, Fen Rhodes, Ph.D.5, Susan Tross, Ph.D.2, Lance S. Weinhardt, Ph.D.3, Robert Weiss, Ph.D.5, Hannah Wolfe, Ph.D.7, Rachel Wolfe, Ph.D.7, Lennie Wong, Ph.D.5 Data Management and Analytic Support: Philip Batterham, M.A.5, Tyson Rogers, M.A.5 Site Project Coordinators: Jackie Correale, M.P.H., Kristin Hackl, M.S.W.3, Daniel Hong, M.A.5, Karen Huchting, B.A.5, Joanne D. Mickalian, M.A.1, Margaret Peterson, M.S.W.3 NIMH: Christopher M. Gordon, Ph.D.4, Dianne Rausch, Ph.D.4, Ellen Stover, Ph.D.4

1. University of California, San Francisco

2. New York State Psychiatric Institute/Columbia University, New York

3. Medical College of Wisconsin, Milwaukee

4. National Institute of Mental Health, Bethesda, Maryland

5. University of California, Los Angeles

6. Beth Israel Medical Center, New York

7. St. Luke’s-Roosevelt Medical Center, New York

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Authors and Affiliations

  1. HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA

    Robert H. Remien, Theresa M. Exner, Anke A. Ehrhardt, Jackie Correale, Stephanie Marhefka & Sheri B. Kirshenbaum

  2. Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA

    Stephen F. Morin, Mallory O. Johnson & Margaret A. Chesney

  3. Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA

    Lance S. Weinhardt & Jeffrey Kelly

  4. Center for Community Health, University of California, Los Angeles, Los Angeles, CA, USA

    Mary Jane Rotheram-Borus

  5. Group Health Center for Health Studies, Seattle, WA, USA

    Sheryl L. Catz

  6. Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA

    Cheryl Gore-Felton

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  1. Robert H. Remien
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  2. Theresa M. Exner
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Remien, R.H., Exner, T.M., Morin, S.F. et al. Medication Adherence and Sexual Risk Behavior among HIV-Infected Adults: Implications for Transmission of Resistant Virus. AIDS Behav 11, 663–675 (2007). https://doi.org/10.1007/s10461-006-9201-8

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