Past Research Studies and Publications

Changing Sexual Behavior among Gay Men Who Test Repeatedly for HIV: 2002-2004

Investigators: James W. Dilley, MD; William Woods, PhD; Joseph Mullan, PhD; and Nicolas Sheon, PhD
The Changing Sexual Behavior Study was based on the findings of the Promoting Safer Sex Practices Study. This randomized, controlled trial involved more than 300 volunteers who sought HIV testing between October 2002 and September 2004. Each participant came to the clinic three times for: a baseline interview, a six-month follow-up interview, and a 12-month exit interview. The interviews were conducted by a computer (using audio computer-assisted self-interview technology) rather than by a live interviewer, and each man received an HIV test at baseline and at exit.

The type of counseling the participant received was assigned at random. Half of the participants received the experimental intervention. Half received standard HIV test counseling. Preliminary analysis indicates that participants in the experimental group decreased their risk by half from the baseline interview to the six-month follow-up, while the control group’s behavior did not change. Further, this study demonstrated that the intervention could be delivered by trained paraprofessionals as well as licensed professionals without compromising the efficacy of the intervention. This is particularly important because a significant amount of HIV antibody counseling and testing is delivered by paraprofessionals.

This new intervention is intended to be quick (taking under one hour to deliver), highly acceptable to clients, and effective at helping men who have sex with men and who repeatedly test decrease their risks of acquiring HIV. The results of this study were published in 2007, see Dilley JW, Woods WJ, Loeb L, Nelson K, Sheon N, Mullan J, Adler B, Chen S, McFarland W.

If You Participated in the Red Studies

If you were a participant in either of the Red studies, thank you for the time you spent with us. If you would like a copy of the results of the study or if you want to contact the research staff, please call us at 415-502-8500 or e-mail us at red@ucsf.edu.

The HIV Oral Transmission Study (HOT): 1998-2003

Investigator: Kimberly Page-Shafer, PhD
The HIV Oral Transmission (HOT) study examined the risk of HIV transmission via oral sex between men. Participants took part in a structured interview regarding sexual practices and oral health in the six months prior to the interview. Each participant received an HIV antibody test and a standardized oral examination performed by a dentist. All 239 male participants were men who had sex with men, the receptive partner, and had an average of three fellatio partners in the prior six months. The median age of the sample was 39 years.

A key strength of this study is that counselors asked participants about their oral sex activities before disclosing HIV test results. It has been found, consistently, that studies which ask individuals how they got infected after disclosing an HIV-positive result, report a higher proportion of orally acquired infections than can be reliably established.

Using a type of antibody testing that could detect infections that occurred within six months of the test, the study found no recently acquired HIV infections. The estimated probability of orally acquired HIV was 0 (95 percent CI 0, 1.5 percent). (“CI” stands for “confidence interval,” a statistical tool that helps researchers measure the precision of their findings.)

The absence of HIV infections detected in this sample confirms previous research that orally acquired HIV infection is rare. HIV prevalence and incidence among men who have sex with men and who tested at the same anonymous testing sites in San Francisco during a similar time period (December 1999 to February 2001) were appreciably higher: overall prevalence of HIV infection was 3.3 percent (95 percent CI 2.9–3.9).

These data confirm that the risk of HIV infection attributable to fellatio among men who have sex with men is extremely low.

It is important that health professionals have valid information to impart to their sexually active clients. If individuals believe that the risk of HIV transmission via fellatio is comparable with activities such as unprotected receptive anal sex, they may not feel that sexual behavior choices make a difference. The fact that acquiring HIV through fellatio is significantly less likely than acquiring it from anal sex does not only offers these men a lower risk choice. The simple fact that there are risk reduction choices—oral sex or protected anal sex, among others—offers hope and empowers risk reduction activities more than if there were only one option.

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