AEGiS-15IAC: Unsafe sexual behavior among homosexual men increases in the era of highly active antiretroviral therapy.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Unsafe sexual behavior among homosexual men increases in the era of highly active antiretroviral therapy.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. MoOrD1090)

Jacobson LP, Ostrow D, Hylton J, Gore ME, Weisberg M, Silvestre A
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States

BACKGROUND: Increases in risky behavior, new HIV infections and outbreaks of sexually transmitted diseases have been reported in the era following the availability of highly active antiretroviral therapies (HAART). The study goals were to determine: 1) whether the increase in risky behavior has persisted, 2) if the increase is directly related to the use of HAART and 3) the characteristics associated with current risky behavior.

METHODS: Using data collected in the Multicenter AIDS Cohort Study, a cohort study of gay men, trends in reporting unprotected anal sex among men with multiple partners were examined from 1995 through 2003. Potential risk determinants (including markers of HIV disease stage, demographics, recreational drug use, and indices of HAART use) were assessed with logistic regression models, controlling for correlated repeated measurements. Population time periods, defined as pre-HAART (up to March 1996), early HAART (April 1996 - March 1998) and HAART-experienced (April1998 - March 2003), were examined as well as direct measures of HAART use.

RESULTS: Compared to the pre-HAART era, reporting risky behavior has significantly increased in the HAART-experienced era; odds ratios (95% confidence intervals) were 2.0 (1.6, 2.4) and 1.6 (1.3,2.1) for the HIV seropositive and seronegative men, respectively. Using at least 3 recreational drugs was independently associated with such behavior. Among HAART users, length of time on therapy, lower education and use of recreational drugs predicted unprotected sex with multiple partners. CD4 cell count and HIV RNA level did not effect behavior.

CONCLUSIONS: The increase in risky sexual behavior is not directly due to the effect of HAART on disease markers, remains linked to recreational drug use, and persists as a major public health problem.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Unsafe Sex, Homosexuality, Homosexuality, Male, HIV Infections, Sexual Behavior, Sexual Partners, CD4 Lymphocyte Count, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Cohort Studies, Humans, Male

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MoOrD1090