HIV This Week

Russell TV, Do AN, Setik E, Sullivan PS, Rayle VD, Fridlund CA, Quan VM, Voetsch AC, Fleming PL. Sexual Risk Behaviors for HIV/AIDS in Chuuk State, Micronesia: The Case for HIV Prevention in Vulnerable Remote Populations. PLoS ONE. 2007; 2(12):e1283.

After the first two cases of locally-acquired HIV infection were recognized in Chuuk State, Federated States of Micronesia, a public health response was initiated. The purpose of the response was to assess the need for HIV education and prevention services, to develop recommendations for controlling further spread of HIV in Chuuk, and to initiate some of the prevention measures. A public health team conducted a survey and rapid HIV testing among a sample of residents on the outer islands in Chuuk. Local public health officials conducted contact tracing and testing of sex partners of the two locally-acquired cases of HIV infection. A total of 333 persons completed the survey. The majority knew that HIV is transmitted through unprotected sexual contact (81%), injection drug use (61%), or blood transfusion (64%). Sexual activity in the past 12 months was reported among 159 participants, including 90 females and 69 males. Compared to women, men were more likely to have had multiple sex partners, to have been drunk during sex, but less likely to have used a condom in the past 12 months. The two men with locally acquired HIV infection had unprotected anal sex with a third Chuukese man who likely contracted HIV while outside of Chuuk. All 370 persons who received voluntary, confidential HIV counselling and testing had HIV negative test results. Despite the low HIV seroprevalence, risky sexual behaviours in this small isolated population raise concerns about the potential for rapid spread of HIV. The lack of knowledge about risks, along with stigmatizing attitudes towards persons infected with HIV and high risk sexual behaviours indicate the need for resources to be directed toward HIV prevention in Chuuk and on other Pacific Islands.

Editors’ note: With only 1500 residents living on this small group of islands, confidentiality would not have been maintained if classical “contact tracing and testing of sex partners”, as implied by the abstract, had occurred. The innovation was for local village officials to convene a public meeting on each of the four islands to explain general health outreach activities, including the offer of HIV testing and counselling. When known contacts of either of the two index cases came forward for HIV testing, health department staff notified them of their potential exposure and provided expanded counselling on HIV risk reduction, without loss of confidentiality. Geographic isolation does not protect people from HIV and the constraints to respecting confidentiality in small populations need to be overcome creatively, as was done here.