افراد مبتلا به اچ آی وی مثبت، ریسک و رفتار جنسی

For a long time, the sexual behaviour of HIV-infected persons did not receive any serious attention for a variety of reasons. Initially, diagnosis of HIV-infection appeared to imply a death sentence. In this context, the sex life of those infected seemed a secondary issue making prevention focused on sexual behaviour hard to imagine. Furthermore, the conviction that stigmatisation should be avoided also precluded an interest in the sexual behaviour of HIV-infected persons. From an epidemiological perspective and in the context of the developments in the medical treatment of AIDS it is important to address the sexuality of HIV-infected people. The scarce research done until now shows that there are various ways in which an HIV-infection affects people's sexuality. It seems that the sexuality of HIV-infected people can be compromised by their infection, inducing various sexual problems. Research also shows that there are HIV-infected people who do engage in unprotected sex, just as there are HIV-negative people or people with unknown serostatus who do so. Studies into the determinants of unsafe sex in HIV-infected people suggest that to some extent the same determinants are operative as among people in general. These include intention and self-efficacy regarding safe sex. Recreational drug use also affects safe sex regardless of serostatus. However, safe sex as well as sex in general is different for seropositive persons than for people who are seronegative or have an unknown serostatus. Among seropositive people, sex is also related to dilemma's involving disclosing their serostatus to potential sex partners, and their motivation to protect their partners as well as themselves against surinfection and STD. Furthermore, having to cope with a serious disease induces negative mood states (particularly depression) and may compromise sexual functioning. Comprehensive prevention aimed at HIV infected persons should address these various issues and should be an integrated part of general HIV-prevention.

Any attempt to assess the contribution of social science research and prevention policy concerning the sexual behaviour of HIV-infected people has to begin with the admission that information on the subject has until recently been rather limited (Nilsson-Schönnesson and Vincke, 1994 and Green, 1995). Before the early 1990s, a few studies provided isolated scraps of knowledge, which were never arranged into a whole. It was only at the 12th World AIDS Conference held in Geneva in 1998 that the issue of sexuality and HIV-infected people received more systematic attention. We are led to wonder why both scientists and people involved remained quiet for so long. This reticence seems all the more paradoxical in that the matter is a central factor in controlling the epidemic. Regardless of the issue of responsibility, HIV-infected people play a central role in the maintenance of the epidemic. In the first section of this paper we will try to understand why this subject failed to emerge more quickly as an important topic for research and prevention. In doing so, we suggest studying the emergence and growth of a group that suffered doubly at a time when medical science was developing in leaps and bounds but when the precepts regarding prevention were uncertain and continued to change. Subsequently we will present an overview of what is known about the issue of being HIV-positive and sexual risks. While we recognise the importance of infected persons in Asia and Africa, no doubt very different from the situation described here in, given the scientific backgrounds of the authors, the inventory of research presented is limited to scientific works on AIDS in developed countries (North America, Europe, Australia). It is of course of major scientific interest to have more comparative research in that field between developing and developed countries.