Behavioral and biologic evidence of persistent high-risk behavior in an HIV primary care population

OBJECTIVE: To define the prevalence of gonorrhea, chlamydial infection, and high-risk sexual behavior in an HIV primary care clinic. DESIGN: Subjects enrolling in this cross-sectional study answered a brief interviewer-administered questionnaire and provided a urine sample for gonorrhea and chlamydia testing. SETTING: A large urban HIV primary care clinic. PARTICIPANTS: HIV-infected patients presenting for a scheduled medical visit from June 1997 to April 1998. MAIN OUTCOME MEASURES: Prevalence of self-reported high-risk sexual behavior and gonorrhea and chlamydial infection. RESULTS: Of 691 patients consenting to the study over a 10-month period, 58% reported sexual activity in the past 90 days, 7.4% reported multiple sexual partners in the past month, and 34.6% did not use a condom at last sexual encounter. Overall, 4.6% reported a history of either gonorrhea or a chlamydial infection in the past year. Of 637 giving a urine sample for testing, the prevalence of chlamydial infection was 2.4%; the prevalence of gonorrhea was 1.6%. Overall, 7.5% of those screened had either current or recent (within 1 year) gonorrhea or chlamydial infection. Current or recent gonorrhea or chlamydial infection was not associated with age, gender, HIV transmission risk, CD4 cell count, HIV viral load, symptoms, or self-reported risk behavior. CONCLUSION: High-risk sexual behavior and unrecognized sexually transmitted diseases (STD) are common among HIV-infected persons followed in primary medical care. Enhanced detection of treatable STD among this population coupled with improved risk-reduction counselling may be important clinical practice measures that can curb the spread of HIV.