Effects of HIV testing and counseling on reducing HIV risk behavior among two ethnic groups.

Abstract

The impact of an HIV testing and counseling program on the risk behaviors of drug users was assessed in 981 African American heroin and crack cocaine users living in the US and 144 Puerto Ricans living both in Puerto Rico and the US. Respondents were part of the US National Institute on Drug Abuse's multi-site Cooperative Agreement for Acquired Immunodeficiency Syndrome Community-Based Outreach/Intervention Research. At each site, active drug injectors and crack cocaine users were selected by targeted sampling methods. The intervention included pre-HIV test counseling, voluntary HIV testing, a post-testing counseling session focused on risk-reduction strategies, and an optional session for HIV-positive participants. The mean age of respondents was 38.5 years; 82.9% were unemployed. 62.5% had a history of sexually transmitted diseases and 12.5% (9.3% of African Americans and 31.9% of Puerto Ricans) were HIV-positive. At baseline, 63.5% of African Americans and 47.2% of Puerto Ricans were engaging in unprotected vaginal intercourse and 3.1% and 8.3%, respectively, were practicing unprotected anal intercourse. Injection risk factors after counseling were independent of HIV test result among African Americans; among Puerto Ricans, a positive HIV test increased the likelihood of shared use of cookers. In both ethnic groups, seropositives were significantly less likely to persist in practicing unprotected vaginal sex. Seropositive African Americans were also less likely to continue to practice unprotected oral sex. Since heterosexual relations with an HIV-positive drug user is a major risk factor for sex partners and children, this screening and counseling program can have a substantial impact on control of the AIDS epidemic in the US.