HIV Transmission in the United States: Considerations of Viral Load, Risk Behavior, and Health Disparities, H. Irene Hall, David R. Holtgrave, Tian Tang, and Philip Rhodes, AIDS and Behavior (March 2013)

This article assesses how viral load, risk behavior, and health disparities contribute to HIV transmission. The authors found that persons who are unaware of their status are more than three times as likely to transmit HIV than those who are aware of their status. Among persons aware of their HIV positive status, higher transmission rates were attributed to risk behavior and unsuppressed viral load. Based on unsuppressed viral loads and the rate of occurrence of unprotected discordant sex within sub- populations, the authors determined that service needs are greatest among men who have sex with men. The study concludes that treatment as prevention to reduce incidence is especially important when persons with unsuppressed HIV viral load engage in risk behavior, and that “[r]esources must be directed to support effective behavior interventions, including access to condoms and sterile syringes, prevention counseling, partner services, substance-abuse treatment, and medication adherence.”