HIV-infected individuals “aware” of their infection are more likely to use condoms, compared to HIV-infected “unaware” persons. To quantify this likelihood, we undertook a systematic review and meta-analysis of U.S. and Canadian studies. Twenty-one eligible studies included men who have sex with men (MSM; k = 15), persons who inject drugs (PWID; k = 2), and mixed populations of high-risk heterosexuals (HRH; k = 4). Risk ratios (RR) of “not always using condoms” with partners of any serostatus were lower among aware MSM (RR 0.44 [not significant]), PWID (RR 0.70) and HRH (RR 0.27); and, in aware MSM, with partners of HIV-uninfected or unknown status (RR 0.46). Aware individuals had lower “condomless sex likelihood” with HIV-uninfected or unknown status partners (MSM: RR 0.58; male PWID: RR 0.44; female PWID: RR 0.65; HRH: RR 0.35) and with partners of any serostatus (MSM only, RR 0.72). The association diminished over time. High risk of bias compromised evidence quality.

与艾滋病毒感染者“不知情”的人相比，艾滋病毒感染者“意识到”自己的感染更有可能使用安全套。为了量化这种可能性，我们对美国和加拿大的研究进行了系统回顾和荟萃分析。 21 项符合资格的研究包括男男性行为者 (MSM；k = 15)、注射吸毒者 (PWID；k = 2) 和高危异性恋者混合人群 (HRH；k = 4)。在有意识的 MSM（RR 0.44 [不显着]）、吸毒者（RR 0.70）和 HRH（RR 0.27）中，与任何血清状态的伴侣“不总是使用安全套”的风险比（RR）较低；以及，在有意识的 MSM 中，与未感染 HIV 或状态未知的伴侣​​ (RR 0.46)。知情者与未感染 HIV 或身份不明的伴侣（MSM：RR 0.58；男性注射吸毒者：RR 0.44；女性注射吸毒者：RR 0.65；HRH：RR 0.35）以及任何血清状态的伴侣（仅 MSM， RR 0.72）。随着时间的推移，这种联系逐渐减弱。高偏倚风险损害了证据质量。