Is use of antiretroviral therapy among homosexual men associated with increased risk of transmission of HIV infection?

Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, Mortimer Market Centre, off Capper Street, London WC1E 6AU, UK.
Sexually Transmitted Infections (Impact Factor: 3.08). 03/2003; 79(1):7-10. DOI: 10.1136/sti.79.1.7
Source: PubMed

ABSTRACT Background/objective: There is concern that use of highly active antiretroviral therapy (HAART) may be linked to increased sexual risk behaviour among homosexual men. We investigated sexual risk behaviour in HIV positive homosexual men and the relation between use of HAART and risk of HIV transmission.
A cross sectional study of 420 HIV positive homosexual men attending a London outpatient clinic. Individual data were collected from computer assisted self interview, STI screening, and clinical and laboratory databases.
Among all men, sexual behaviour associated with a high risk of HIV transmission was commonly reported. The most frequently reported type of partnership was casual partners only, and 22% reported unprotected anal intercourse with one or more new partners in the past month. Analysis of crude data showed that men on HAART had fewer sexual partners (median 9 versus 20, p=0.28), less unprotected anal intercourse (for example, 36% versus 27% had insertive unprotected anal intercourse with a new partner in the past year, p=0.03) and fewer acute sexually transmitted infections (33% versus 19%, p=0.004 in the past 12 months) than men not on HAART. Self assessed health status was similar between the two groups: 72% on HAART and 75% not on HAART rated their health as very or fairly good, (p=0.55). In multivariate analysis, differences in sexual risk behaviour between men on HAART and men not on HAART were attenuated by adjustment for age, time since HIV infection. CD4 count and self assessed health status.
HIV positive homosexual men attending a London outpatient clinic commonly reported sexual behaviour with a high risk of HIV transmission. However, behavioural and clinical risk factors for HIV transmission were consistently lower in men on HAART than men not on HAART. Although use of HAART by homosexual men with generally good health is not associated with higher risk behaviours, effective risk reduction interventions targeting known HIV positive homosexual men are still urgently needed.

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    • "There is also a rise in the number of men infected with HIV, where nearly one in every four homosexual men is HIV-positive (CENTRE D'ESTUDIS EPIDEMIOLÒGICS SOBRE LA SIDA DE CATALUNYA, 2006), and where prevalence rates of some STIs, such as syphilis, continue to climb (VALL MAYANS et al., 2006). [1] The most common explanations for the current tendencies towards unprotected sex include difficulties with using a condom (for example loss of erection) (ADAM, HUSBANDS, MURRIA & MAXWELL, 2005), optimism with regard to HIV owing to advances in treatment (STEPHENSON et al., 2003; CREPAZ, HART & MARKS, 2004), fatigue regarding the prevention of AIDS (STOCKMAN et al., 2004), and the consumption of alcohol and recreational drugs (HIRSHFIELD, REMIEN, HUMBERSTONES, WALAVALKAR & CHIASSON, 2004; KOBLIN et al., 2006). However, the majority of studies of high-risk sexual behavior ignore the circumstances which could explain these episodes of unprotected sex among men who otherwise have the necessary knowledge, motivation, and ability to practice safer sex (DÍAZ, 1999). "
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    ABSTRACT: Currently there is a growing trend toward high-risk sexual practices with casual partners in the group of men who have sex with men (MSM) in many industrialized countries. This study offers some understanding of why a group of men had unprotected anal intercourse (UAI). A grounded approach was used to analyze 20 interviews with MSM from Barcelona between 18 and 40 years of age who had at least one episode of UAI in the past three months. The results reveal that many respondents had UAI practices with casual sexual partners because they were in search of experiences that were not directly tied to sexual relations: reaffirmation of a sense of personal worth and of their own physical attractiveness, offset shortcomings and feelings of emotional loneliness, the search for connection and intimacy, being in love, conversion of the risk into pleasure for the forbidden and a desire to rebel against established rules. In these cases, concerns about sexual and health care seemed to overwhelm and were not taken into account when having UAI. It is important that HIV prevention programs include in their messages the power of these motivations that lead to practices of UAI. Existe una creciente tendencia hacia prácticas sexuales de alto riesgo con parejas ocasionales en el colectivo de hombres que tienen sexo con hombres (HSH) de muchos países industrializados. Este estudio ofrece un entendimiento de algunos motivos por los que un grupo de HSH tuvo prácticas de penetración anal sin condón (PASC). Una aproximación fundamentada fue utilizada para analizar 20 entrevistas semiestructuradas a HSH de Barcelona, entre 18 y 40 años, quienes tuvieron, al menos, un episodio de PASC en los últimos tres meses. Los resultados revelan que muchos entrevistados tuvieron prácticas de PASC con parejas sexuales ocasionales porque fueron en búsqueda de experiencias que no estuvieron relacionadas directamente con las sexuales: reafirmación del sentido de valía personal y del propio atractivo físico, compensar carencias afectivas y sentimientos de soledad, búsqueda de conexión e intimidad, estar enamorado, conversión del riesgo en placer por lo prohibido y deseo por rebelarse contra las normas establecidas. En estos casos, la preocupación por el cuidado sexual y la salud pareció ser abrumadora y no tomada en cuenta al momento de tener PASC. Sería importante que los programas de prevención del VIH incluyan en sus mensajes el poder de estas motivaciones que llevan a prácticas de PASC.
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    • "Previous research has shown that when presented with the statement: " As an HIV positive man I should feel an extra responsibility not to pass on HIV to another person " , 87% of men with diagnosed HIV agreed (Stephenson et al. 2003: 9). However, when presented with the statement: " HIV positive gay men have more responsibility to practice safer sex than HIV negative men " , far fewer (35%) agreed. "
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    • "This research is based on two series of qualitative interviews with gay men with HIV. The first sequence of 25 interviews was conducted for research funded by the UK Medical Research Council concerning HIV treatment and sexual behaviour (Stephenson et al. 2003). These interviews addressed experiences with HIV diagnosis and treatment, sexual practice and HIV prevention. "
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    ABSTRACT: Increases in reported unsafe sex among gay men have been explained as resistance to HIV prevention, or most recently, with the idea that a hyper-individualization of sexual action contributes to the loss of sexual community. This turning in HIV prevention has come to focus on the sexual action of gay men with HIV through the frames of: sexual transgression, sometimes called 'barebacking'; and altruism. Adopting the perspective of sexual citizenship in connection with qualitative interviews, this paper considers how gay men with HIV account for their sexual practice in light of the dual discourse of transgression/altruism. The paper will argue that gay men with HIV are deeply aware of what transgression/altruism implies for their identities and sexual relations, indicating the continued salience of community for sexual practice. Further, in the circumstances of blaming in relation to the moral labour of safer sex, gay men with HIV are trying to work out a co-operative practice for HIV prevention based on self-care, a moderated altruism and the voluntary action of sexual partners.
    Sociology of Health & Illness 04/2008; 30(2):182-96. DOI:10.1111/j.1467-9566.2007.01050.x · 1.88 Impact Factor
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