Sexual risk behavior and behavior change among persons newly diagnosed with HIV: the impact of targeted outreach interventions among hard-to-reach populations.

The secondary effect of a national, targeted, outreach initiative in reducing sexual risk behavior among newly diagnosed persons living with HIV/AIDS (PLWHA) was examined in the present study. The findings propose an optimal number of outreach program contacts associated with a change in sexual risk behavior. The primary goal of the initiative was to implement and evaluate strategies to engage and retain underserved populations (PLWHA) in HIV primary medical care. Participants from 10 sites nationwide were enrolled in outreach interventions from 2004 to 2005 that were designed to engage and retain hard-to-reach PLWH in care. The study population in the subanalysis performed was predominantly male, people of color, sexual minorities; mean age of 32, and 31% reported no visits to an HIV health provider since testing positive. The study design was prospective and nonrandomized; 116 newly diagnosed individuals reported on unprotected sex at baseline, 6-, and 12-month interviews. The proportion of individuals reporting unprotected sex postintervention was reduced significantly compared to baseline. Postbaseline, individuals were 80% less likely to report unprotected sex. Additionally, individuals with 1-3 program contacts per month were 80 times less likely to report risky sexual behavior compared to those with 2 or less contacts (adjusted odds ratio [AOR] = 0.20). Substantial risk exists for secondary HIV transmission; this study shows the promise of a supplemental intervention to ensure access to HIV care, retention in care, and risk reduction for positives.