Availability of combination therapy for HIV: effects on sexual risk taking in a sample of high-risk gay and bisexual men

Ongoing sexually transmitted disease acquisition and risk-taking behavior among US HIV-infected patients in primary care: implications for prevention interventions

BACKGROUND

To better understand the factors associated with HIV- and sexually transmitted disease (STD)-transmitting behavior among HIV-infected persons, we estimated STD prevalence and incidence and associated risk factors among a diverse sample of HIV-infected patients in primary care.

METHODS

We analyzed data from 557 participants in the SUN Study, a prospective observational cohort of HIV-infected adults in primary care in 4 US cities. At enrollment and 6 months thereafter, participants completed an audio computer-assisted self-interview about their sexual behavior, and were screened for genitourinary, rectal, and pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis infections by nucleic acid amplification testing, and for serologic evidence of syphilis. Women provided cervicovaginal samples and men provided urine to screen for Trichomonas vaginalis by polymerase chain reaction.

RESULTS

Thirteen percent of participants had a prevalent STD at enrollment and 7% an incident STD 6 months later. The most commonly diagnosed infections were rectal chlamydia, oropharyngeal gonorrhea, and chlamydial urethritis among the men and trichomoniasis among the women. Other than trichomoniasis, 94% of incident STDs were identified in men who have sex with men. Polysubstance abuse other than marijuana, and having ≥4 sex partners in the 6 months before testing were associated with diagnosis of an incident STD.

CONCLUSIONS

STDs were commonly diagnosed among contemporary HIV-infected patients receiving routine outpatient care, particularly among sexually active men who have sex with men who used recreational drugs. These findings underscore the need for frequent STD screening, prevention counseling, and substance abuse treatment for HIV-infected persons in care.

Beliefs about transmission risk and vulnerability, treatment adherence, and sexual risk behavior among a sample of HIV-positive men who have sex with men

Advances in HIV treatment have generated optimistic beliefs about HIV transmission risk and sexually transmitted infection vulnerability, which can influence motivation to practice safer sex. This study sought to better understand the relationships between these beliefs and different types of sexual risk behavior. A second objective was to determine the association between treatment adherence and sexual risk behaviors. Data collected from 842 HIV-positive men who have sex with men on treatment were examined. Eleven questions measured beliefs regarding HIV transmission risk and vulnerability to other infections or negative health outcomes. The main outcomes were concordant and discordant unprotected anal sex with main and non-main male partners. Thirty-four percent reported concordant and 41% reported discordant unprotected anal sex in the past three months: 26% reported discordant insertive unprotected anal sex. In all multivariate logistic regression models predicting sexual risk behaviors, at least one belief item remained statistically significant. Different patterns of associations between beliefs and sexual risk were observed across partner type and serostatus. Compared to transmission risk beliefs, more vulnerability beliefs were associated with sexual risk. Missing at least one treatment dose in the past month was associated with concordant and discordant sexual risk with non-main partners, while intentionally missing a dose was associated with only discordant risk with non-main partners. Post hoc moderator analysis explored potential interaction between beliefs and adherence. The belief that a low viral load lowers transmission risk was positively associated with discordant sex with non-main partners only among those who missed a dose intentionally. These results underscore the complex relationship between HIV transmission risk and vulnerability beliefs and sexual behavior with different types of partners. Prevention programs should carefully consider how to craft and tailor messages about medical advances while at the same time reinforcing the need for continued sexual safety.

Unsafe sexual behavior among HIV-infected patients in Croatia, 2006: prevalence and associated factors

Information about risky sexual behavior among people living with HIV/AIDS is important to prevent the spread of the disease. Using an anonymous, self-administrated questionnaire, we surveyed 185 HIV-infected patients about risk behaviors at the University Hospital for Infectious Diseases in Croatia. Unprotected anal or vaginal sex in the preceding 6 months with partners of uninfected/unknown HIV status was reported by 20% of men who have sex with men (MSM), about half of whom reported multiple casual partners of unknown HIV status; 6% of heterosexual men; and 3% of women. Heterosexual patients were potentially more likely to expose regular partners to HIV but reported no risk behaviors with casual, non-concordant partners. MSM reported more risk behaviors, which were strongly associated with having > or = 2 sexual partners in the last 6 months and both insertive and receptive anal sex. Educational interventions in Croatia should target MSM to prevent high rates of HIV transmission.

Association between risk of acquiring HIV and beliefs and perceptions about the lived experience of HIV/AIDS among HIV-negative or untested men who have sex with men

The study aim was to assess whether the sexual behaviour of HIV-negative or untested men who have sex with men (MSM) was related to their perceptions of what it is like to live with HIV/AIDS, their beliefs or their attitudes to highly active antiretroviral treatments. Any unprotected anal intercourse (UAI) with casual partners was used as the sexual-risk indicator. The study enrolled 261 MSM. There were no significant differences between beliefs, attitudes and perceptions about HIV/AIDS, knowledge of post-exposure prophylaxis (PEP) or exposure to the HIV/AIDS epidemic among those who had had UAI with casual partners and those that had not (P>0.12). Those who considered that low levels of viral load and withdrawing before ejaculation reduced the risk of HIV transmission were significantly more likely to have had UAI with a casual partner (P=0.03). Only a minority of MSM engaging in UAI were optimistic about antiretroviral therapy. The study participants were in general pessimistic about life with HIV/AIDS despite their risk-taking sexual behaviour.

Safe sex after post-exposure prophylaxis for HIV: Intentions, challenges and ambivalences in narratives of gay men

This paper draws on findings from an on-going prospective cohort study, with a quantitative and a qualitative arm, to monitor the implementation of non-occupational post-exposure prophylaxis (PEP) in Australia. The aim of the qualitative arm was to explore in-depth details of exposures to HIV and participants' understanding of 'risk'. Of the 328 patients who were enrolled in the study from March 1999 to July 2001, 88 (27%) participated in the qualitative arm. Interviews were conducted in a semi-structured style and explored the event that precipitated the request for PEP, participants' understanding of safe sex, their physical and psychological experience of the treatment and the impact that the availability of PEP may have on their sexual practices in the future. One theme running through the interviews was a determination to either maintain existing high levels of safe sex or to increase safe sex practices in those men who perceived PEP as 'a wake up call'. This determination was motivated by the experience of taking combination therapies and reflection on a potentially HIV-positive future. However, there were also tensions and ambivalences in the narratives. PEP was promoted as an adjunct to safe sex, not as an alternative. This is how PEP was understood by the men in this study.

Substance use and high-risk sex among men who have sex with men: a national online study in the USA

This paper describes drug and sexual risk behaviors during a six-month period in 2001 of 2,916 gay and bisexual men who were recruited online. Bivariate and multivariate analyses examined correlates of unprotected anal intercourse (UAI). Drug and alcohol use were also examined by US region. UAI was associated with using alcohol or drugs, including poppers, crystal methamphetamine, cocaine, marijuana and Viagra before or during sex. Meeting sex partners both online and offline and having multiple sex partners were also predictive of UAI. Significant regional differences were seen in the prevalence of drug use and alcohol use. Findings are discussed in relation to the need to integrate messages about the relationship between drug use and sexual behavior into HIV prevention programs.

Incidence of Sexually Transmitted Diseases and HIV Infection Related to Perceived HIV/AIDS Threat Since Highly Active Antiretroviral Therapy Availability in Men Who Have Sex With Men

OBJECTIVE

Concerns have been expressed regarding increase in risky sex because of the availability of antiretroviral treatments in Western countries.

GOAL

The goal of this longitudinal study was to investigate the association between highly active antiretroviral therapy (HAART)- and postexposure prophylaxis-related beliefs and the incidence of sexually transmitted diseases (STDs) and new HIV infections in men who have sex with men (MSM).

STUDY

Data on the incidence of STDs and new HIV infection, and the level of agreement with different HAART- and PEP-related beliefs from 151 HIV-negative MSM were compiled.

RESULTS

Of all MSM, 65.6% tested negative for any STDs and 7 men HIV seroconverted. Perceiving less HIV/AIDS threat since HAART availability and younger age were significantly associated with a higher incidence of STDs. Perceiving less need for safe sex since HAART availability was significantly associated with an increased likelihood of HIV seroconversion.

CONCLUSIONS

The results support the assumption that there is an association between the incidence of STDs and a decreased perception of HIV/AIDS threat resulting from HAART availability. Less perceived need for safe sex since HAART availability was associated with HIV seroconversion.