Date of Award


Document Type


Degree Name

Medical Doctor (MD)

First Advisor

Krystn Wagner


Since the beginning of the HIV epidemic, aggressive educational initiatives have helped to slow the spread of infections dramatically. However, since 1992, the number of new HIV infections in the United States has remained stable. Sustained rates of new HIV infections have been attributed to increases in unsafe sexual practices and an intersecting epidemic of sexually transmitted diseases (STDs). Mounting evidence has contributed to the recognition of the mutually reinforcing relationship between HIV and other STDs, highlighting the significance of secondary prevention of HIV. Nevertheless, studies nationwide indicate that counseling of HIV-positive patients in primary care settings is inadequate. The objective of this investigation was to assess the delivery of safer-sex counseling to HIV-positive patients followed at an urban HIV clinic. A convenience sample of eighty-nine patients agreed to be interviewed with regards to their knowledge of the risks of unsafe sex, their experiences with safe-sex counseling, and the impact that safer-sex counseling had on their behavior. Most patients (89%) reported sexual activity since being diagnosed with HIV and 22% admitted that their behaviors put either themselves or their partners at risk. Most were aware of the risks of acquiring an STD (63%) or transmitting HIV (60%), but many did not know about the risk of superinfection with drug-resistant HIV. The majority of patients use protection in the form of condoms (73%) or a combination of condoms and abstinence (11%). Many, however, reported that they used no protection (15%). Barriers to safe sex included inconvenience, oral sex, alcohol, drugs and anonymous sex. Most patients reported that they had been counseled by their providers, 43% of which reported changing their behavior as a result. Most importantly, nearly all patients (87/89) reported feeling comfortable discussing secondary prevention with their providers. Providers that have frequent contact with HIV-positive patients can have a tremendous impact in reducing high-risk behaviors through specifically tailored prevention messages delivered in a compassionate and non-judgmental manner.


This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.