Too many people who test positive for the AIDS virus at Baltimore's city-run clinics continue to engage in sexual intercourse without a condom despite counseling aimed at stemming the epidemic's spread, a researcher has said.
A new study has found that 15 percent of a sample group of 615 patients who received counseling after testing positive for the AIDS virus returned within a year with a different sexually transmitted disease such as gonorrhea or syphilis. "Clearly, what we do now is inadequate," said Dr. Jonathan Zenilman yesterday, a Johns Hopkins specialist in infectious diseases who also works with Baltimore's sexually transmitted disease clinics. There, he directs a program for patients who test positive for the human immunodeficiency virus, which causes AIDS. "To expect a single post-test counseling [session] to reduce one's high risk behavior is overly optimistic," he said.
Since 1981, more than 2,400 city residents have been diagnosed with full-blown AIDS. About 1,600 of them have died. Experts, however, estimate that for every patient who suffers from the disease, there are another six people who carry the virus but have yet to develop symptoms of AIDS.
Dr. Zenilman said his study is limited because it reflects people who voluntarily returned to one of two city clinics after noticing symptoms of a venereal disease. Others may have chosen an emergency room or private doctor -- or avoided medical treatment altogether.
Also, the results don't reflect patients who practiced risky sex but did not contract another sexual disease. The study, reported in today's Journal of the American Medical Association, tracked patients seen at the clinics between January 1988 and July 1989.
He estimated that 30 percent of the people who carry the AIDS virus -- twice the rate documented in the survey -- may actually be catching venereal diseases after being counseled. "And the the number of carriers having sex without condoms [is] greater still," he said.
Although counseling hasn't worked as well as planned, it apparently has had some effect. People who got less advice because they tested negative for the AIDS virus were even more likely to practice risky sex.
While 15 percent of the HIV-positive people acquired new sexual diseases, 22 percent of 694 people who tested negative for HIV returned with other sexually transmitted diseases in about a year.
Dr. Zenilman said the study clearly illustrates the difficulty of significantly changing sexual practices through counseling. Officials at the city clinics are studying other ways to get the point across.
Patients who learn they are infected at a city clinic speak to a counselor, who tells them what the results mean, how the disease progresses and how to avoid passing the virus to others. This includes condom use, limiting the number of sexual partners and refraining from sharing needles.