Friday, October 31, 2003
A story released today by Aids Map reports that according to preliminary results of the first ever study to show the impact of relationships on hard clinical outcomes in HIV disease, presented this week at the Ninth European AIDS Conference in Warsaw, HIV-positive people in a "stable relationship" do better than single people.
Researchers from Switzerland undertook a five year prospective cohort study in 3736 patients with HIV who were part of the 11867-strong Swiss HIV Cohort Study, and included all those who started HAART prior to 2002, and who had answered their questionnaire.
The median age of those included in this study was 36 and 29% were women. The main measurement was the time to AIDS or death, but CD4 cell counts and viral load were also measured, and the median follow-up time was 3.6 years.
When asked in a questionnaire if they had had a stable sexual partner during the past six months, 2985 (80%) responded 'yes' on at least one occasion. The researchers reported that women were more likely than men to be in a stable relationship, and that people over 40 were more likely to be single.
The study raised more questions than it could answer, however, and was subject to various limitations, including having only one question about stable sexual partnerships to measure relationships. For example, the study did not differentiate between people who were serial monogamists with long-term partnerships, nor did it differentiate between those who answered 'yes' once or on every occasion.
The authors also suggested that it was primarily the social support provided by the partner that was the significant factor in the beneficial outcome, and said that they felt single people were more likely to be depressed and therefore non-adherent to medication. However, this conflicts with their own evidence that found no relationship between successful viral suppression and a stable partnership.
When asked about lifestyle factors that could have contributed to the outcome of this study, the author noted that one in four people in this cohort were intravenous drug users - many of whom are not in stable relationships - and that death by homicide or overdose could have played a role in the study's outcome.
One obvious area for further research would be sexual and lifestyle factors. For example, the assumption that those with a partner are monogamous and less likely to be exposed to other sexual pathogens than single people needs to be examined, particularly in the context of same-sex relationships. Furthermore, the assumption that only single people are depressed, and therefore non-adherent, is arguably false, and needs further exploration and elucidation.