HIV status of sexual partners is more important than antiretroviral treatment related perceptions for risk taking by HIV positive MSM in Montreal, Canada

Montreal Public Health Department, Montreal, Quebec, H2L 1M3 Canada.
Sexually Transmitted Infections (Impact Factor: 3.08). 01/2005; 80(6):518-23. DOI: 10.1136/sti.2004.011288
Source: PubMed

ABSTRACT To examine the role of antiretroviral treatment related perceptions relative to other clinical and psychosocial factors associated with sexual risk taking in HIV positive men who have sex with men (MSM).
Participants were recruited from ambulatory HIV clinics in Montreal. Information on sociodemographic factors, health status, antiretroviral treatment related perceptions, and sexual behaviours was collected using a self administered questionnaire. At-risk sexual behaviour was defined as at least one occurrence of unprotected insertive or receptive anal intercourse in the past 6 months. Multivariate logistic regression was performed to evaluate the associations between at-risk sexual behaviour and covariates.
346 subjects participated in the study. Overall, 34% of subjects were considered at risk; 43% of sexually active subjects (n=274). At-risk sexual behaviour was associated with two antiretroviral treatment related perceptions: (1) taking antiretroviral treatment reduces the risk of transmitting HIV (adjusted odds ratio (OR), 2.10; 95% confidence interval (CI), 1.16 to 3.80); and (2) there is less safer sex practised by MSM because of HIV treatment advances (OR, 1.82; CI, 1.14 to 2.90). Other factors, however, were more strongly associated with risk. These were: (1) safer sex fatigue (OR, 3.23; CI, 1.81 to 5.78); (2) use of "poppers" during sexual intercourse (OR, 6.28; CI, 2.43 to 16.21); and (3) reporting a greater proportion of HIV positive anal sex partners, compared with reporting no HIV positive anal sex partners: (a) <50% HIV positive (OR, 16.79; CI, 4.70 to 59.98); (b) > or =50% HIV positive (OR, 67.67; CI, 15.43 to 296.90).
Despite much emphasis on HIV treatment related beliefs as an explanation for sexual risk taking in MSM, this concern may play a relatively minor part in the negotiation of risk by HIV positive MSM. Serosorting, safer sex fatigue, and the use of poppers appear to be more important considerations in understanding the sexual risk behaviours of HIV positive MSM.

  • Source
    • "According to a longitudinal study that reported a positive Nattrass association between practicing unsafe sex and HIV optimism, the rise in unsafe sex over time was unrelated to such attitudes and thus could not be explained by them (Elford, Bolding & Sherr, 2002, p. 1542). The rise in unsafe sex may be a consequence of factors other than the availability of HAART — factors such as the replenishment of individuals who enjoy unsafe sex in the population (Boily, Godin Hogben, Sherr & Bastos, 2005), increasing use of 'poppers' (Cox, Beauchemin & Allard, 2004), the rise of Internet dating (Elford et al., 2002; Halkitis & Parsons, 2003), broader changes in sexual culture towards less open discussion of HIV (Morin, Vernon, Harcourt, Steward, Volk, Riess, Neilands, McLaughlin & Coates, 2003) and safe-sex fatigue (Sepkowitz, 2000; Cox et al., 2004). If the rise in new HIV infections is unrelated to HAART, then rolling out HAART to more people will reduce the number of new infections (Blower et al., 2000). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper shows how two publicly available epidemiological modelling packages, namely the Spectrum AIDS Impact Model and the ASSA2003 AIDS and Demographic Model, predict very different impacts from rolling out highly active antiretroviral treatment (HAART) on new HIV infections. Using South Africa as a case study, it shows that the ASSA2003 model predicts a significant drop in new HIV infections as HAART is rolled out, whereas the Spectrum model assumes that HAART does not have a preventative impact (and in fact generates a small increase in new HIV infections). Users will thus draw different conclusions about the public health benefits of HAART depending on which modelling package they use. Despite being presented as a policy-oriented modelling tool capable of exploring 'what if' questions about the impact of different policy choices, the Spectrum model is illequipped to do so with regard to a HAART rollout. Unlike Spectrum, ASSA2003 is more flexible and its assumptions are clear. Better modelling and more information (including about the relationship between HAART and sexual risk behaviour) is required to develop appropriate public-policy modelling for the HAART era.
    African Journal of AIDS Research 11/2009; August 2007(2-Vol. 6):129-137. DOI:10.2989/16085900709490407 · 0.61 Impact Factor
  • Source
    • "Goode, 2001), os resultados desta investigação parecem indicar que esse comportamento em essência não se prende com a procura activa de infecção pelo VIH, mas eventualmente mais com outros factores, tais como a procura de intimidade e de prazer (Carballo-Dieguéz et al., 2006) ou a erotização do risco sexual (Junge, 2002). Além disso, muitos homens que optam por não utilizar preservativos, pelos motivos mencionados ou outros, recorrem frequentemente a uma outra estratégia de prevenção do contágio pelo VIH que é a escolha de parceiros do mesmo estatuto serológico (serosorting, em Inglês) (Cox, Beauchemin & Allard, 2004; Clatts, Goldsamt & Yi, 2005; Parsons et al., 2006). Apesar de não tão eficaz quanto à utilização de preservativos no acto sexual, esta escolha estratégica de parceiros é considerada por muitos como uma forma alternativa de prevenção. "
    12/2006; 25(3):351-361. DOI:10.14417/ap.450
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Symptomatic primary HIV infections are over-represented in the mainly hospital-based studies on transmission of resistant HIV-1. We examined a more general population for the prevalence of resistant HIV-1 strains among primary infections. From 1994 to 2002 primary infections were identified within the Amsterdam Cohort Studies (ACS) among homosexual men and drug users, and at the Academic Medical Center (AMC). Whereas primary HIV-1-infected AMC patients, often presented with symptoms of acute retroviral syndrome, ACS participants largely seroconverted during follow-up and thus brought also asymptomatic primary infections to our study. Reverse transcriptase (RT) and protease sequences were obtained by population-based nucleotide sequence analysis of the first HIV RNA-positive sample available. Subtypes were identified by phylogenetic analysis. Mutations were identified based on the IAS-USA resistance table. A total of 100 primary HIV-1 infections were identified (32 AMC and 68 ACS). Transmission of drug-resistant strains decreased over calendar time, with 20% [95% confidence interval (CI), 10-34%] of infections bearing drug-resistant mutations before 1998 versus only 6% (95% CI, 1-17%) after 1998. No multi-drug resistance pattern was observed. The median plasma HIV-1 RNA level of the first RNA positive sample was significantly lower for the individuals infected with a resistant strain versus those infected with wild-type, suggesting a fitness-cost to resistance. Four of seven non-B subtypes corresponded with the prevalent subtype in the presumed country of infection, and none showed resistance mutations. The transmission of drug-resistant HIV-1 strains in Amsterdam has decreased over time. Monitoring should be continued as this trend might change.
    AIDS 08/2004; 18(11):1571-7. DOI:10.1097/01.aids.0000131357.52457.33 · 6.56 Impact Factor
Show more


Available from