Article

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: 3.4). 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.

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    • "Studies involving HIV-infected MSM have found that HIV-infected MSM less concerned about transmitting HIV infection to sex partners because of ART availability were more likely to engage in unprotected anal intercourse [64, 68] . In Canada, risky behavior was associated with the perception that ART reduced the risk of HIV transmission and that increased unsafe sex was related to advances in treatment for HIV infection; however, other factors, such as safer sex fatigue, use of poppers, and serosorting, were more strongly correlated with unsafe risk be- havior [69]. In an Australian cohort, frequent unprotected anal intercourse with casual partners was reported more often by HIV-infected MSM receiving ART, although 70.7% of unprotected anal intercourse with casual partners was reported by a minority (10%) of participants [70]. "
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