Screening for transmission behaviors among HIV-infected adults

Existing data suggest that a substantial proportion of HIV seropositive adults reduce their substance use and sexual risk behaviors after learning their serostatus. Given the importance of implementing preventive interventions, a screening tool is desirable to allow for a brief method of identifying those who continue to engage in transmission acts. This report explores the sensitivity and specificity of a brief screener used to identify persons living with HIV who engage in unprotected sexual intercourse and/or injection drug use. HIV positive clients of a large AIDS service organization in Los Angeles (N = 178) were screened with a brief, 7-item questionnaire, and responses on the screening interview were compared with self-reports obtained in an in-depth computerized assessment administered on the same day. Participants were randomized to receive the in-depth computerized assessment administered by an interviewer, or a self-administered audio-computer assisted interview. Screener sensitivity and specificity rates were relatively low (68% and 78%, respectively), and sensitivity was lower among African Americans than non-African Americans. Multivariate logistic regression analyses indicated that false negative screener responses were associated with recent sexually transmitted disease experience, controlling for gender, ethnicity, and interview administration mode. Effective strategies need to be developed that screen persons living with HIV who may be transmitting HIV to their sexual or drug-injecting partners.