title: Routine brief risk-reduction counseling with biannual STD testing reduces STD incidence among HIV-infected men who have sex with men in care.
abstract: BACKGROUND
  We evaluated whether routine biannual sexually transmitted disease (STD) testing coupled with brief risk-reduction counseling reduces STD incidence and high-risk behaviors.
  
  
  METHODS
  The SUN study is a prospective observational HIV cohort study conducted in 4 US cities. At enrollment and every 6 months thereafter, participants completed a behavioral survey and were screened for STDs, and if diagnosed, were treated. Medical providers conducted brief risk-reduction counseling with all patients. Among men who have sex with men (MSM), we examined trends in STD incidence and rates of self-reported risk behaviors before and after exposure to the risk-reduction intervention. The "preintervention" visit was the study visit that was at least 6 months after enrollment STD screening and treatment and at which the participant was first exposed to the intervention. The "postintervention" visit was 12 months later.
  
  
  RESULTS
  Among 216 MSM with complete STD and behavioral data, median age was 44.5 years; 77% were non-Hispanic white; 83% were on highly active antiretroviral treatment; 84% had an HIV RNA level <400 copies/mL and the median CD4 (cluster of differentiation 4) count was 511 cells/mm. Twelve months after first exposure to the risk-reduction intervention, STD incidence declined from 8.8% to 4.2% (P = 0.041). Rates of unprotected receptive or insertive anal intercourse with HIV-positive partners increased (19% to 25%, P = 0.024), but did not change with HIV-negative partners or partners of unknown HIV status (24% to 22%, P = 0.590).
  
  
  CONCLUSIONS
  STD incidence declined significantly among HIV-infected MSM after implementing frequent, routine STD testing coupled with risk-reduction counseling. These findings support adoption of routine STD screening and risk-reduction counseling for HIV-infected MSM.
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. plp3@cdc.gov
authors.forename: Pragna
authors.initials: P
authors.lastname: Patel
authors.forename: Tim
authors.initials: T
authors.lastname: Bush
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mayer
authors.forename: Joel
authors.initials: J
authors.lastname: Milam
authors.forename: Jean
authors.initials: J
authors.lastname: Richardson
authors.forename: John
authors.initials: J
authors.lastname: Hammer
authors.forename: Keith
authors.initials: K
authors.lastname: Henry
authors.forename: Turner
authors.initials: T
authors.lastname: Overton
authors.forename: Lois
authors.initials: L
authors.lastname: Conley
authors.forename: Gary
authors.initials: G
authors.lastname: Marks
authors.forename: John T
authors.initials: JT
authors.lastname: Brooks
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003376:Counseling / Q000379:methods*; D006679:HIV Seropositivity / Q000453:epidemiology / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011446:Prospective Studies; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D012747:Sexual Partners / Q000523:psychology; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*