AEGiS-13IAC: Attitudes Towards Highly Active Antiretroviral Therapy Predict Sexual Risk-taking among HIV-Infected and Uninfected Gay Men in the Multicenter AIDS Cohort Study (MACS).

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Attitudes Towards Highly Active Antiretroviral Therapy Predict Sexual Risk-taking among HIV-Infected and Uninfected Gay Men in the Multicenter AIDS Cohort Study (MACS).

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. ThOrC719)

Ostrow DG, Fox K, Chmiel JS, Silvestre A, Visscher BR, Vanable P, Jacobson LP, Strathdee SA
D. G. Ostrow, Howard Brown Health Center, 4334 N. Hazel Street, Room 106, Chicago, IL 60613, United States, Tel.: +1 773 525 0246, Fax: +1 773 525 0387, E-mail: dostrow@interaccess.com

OBJECTIVE: To determine if attitudes towards HAART are associated with unprotected anal sex among HIV- and HIV+ gay men.

METHODS: Gay men enrolled in the MACS in 1984-85 or 1987-91 underwent semi-annual surveys, HIV tests and laboratory assays. In 1999, men completed a 20-item pre-validated scale on attitudes towards HAART and risk behaviors (e.g., "Because of HAART, I am less concerned about becoming HIV+ or infecting someone"). Logistic regression was used to determine whether scores on 6 attitudinal sub-scales were associated with unprotected receptive anal sex (RAS) and insertive anal sex (IAS) in the prior 6 months, adjusting for number of partners, demographics, viral load, CD4 count and use of HAART.

RESULTS: Of 548 men (219 HIV- and 329 HIV+) reporting anal sex in the prior 6 months, mean age was 45; 83% were Caucasian. Relative to HIV+ men, HIV- men reported more male sex partners (median: 5 vs. 4, p = 0.03). There were no significant differences for unprotected RAS and IAS by HIV-serostatus (approx. 50%). Among HIV- men, those agreeing that HAART lessened their concern about becoming HIV+ were more likely to report unprotected RAS (AdjOR = 2.6; 95% CI: 1.1-6.4). Among HIV+ men, those agreeing that HAART reduced concern about infecting someone were more likely to report unprotected IAS (AdjOR = 8.8; 95% CI: 3.3-23.9) and RAS (AdjOR = 3.5; 95% CI = 1.4-8.5). HIV "burnout" (e.g., "tired of always having safer sex") was independently associated with a four-fold increase in the odds of IAS and RAS among HIV+ men (p>0.001).

CONCLUSIONS: Despite reductions in HIV risk behaviors earlier in the epidemic, approximately half of HIV- and HIV+ gay men reporting anal sex do not consistently use condoms. Decreased concern about HIV transmission due to HAART was associated with sexual risk taking. HIV "burnout" also independently predicted unprotected anal sex among HIV+ men. Prevention programs should take into account underlying reasons for unprotected sex in the era of HAART.

Keywords: AEGIS, Homosexuality, Male, Antiretroviral Therapy, Highly Active, Homosexuality, Acquired Immunodeficiency Syndrome, Risk-Taking, HIV Infections, Sex Behavior, HIV Seropositivity, Viral Load, Safe Sex, CD4 Lymphocyte Count, Condoms, Attitude, Sexual Partners, Multicenter Studies, Health Knowledge, Attitudes, Practice, Human, Male
000709
ThOrC719