title: Attitudes towards highly active antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men.
abstract: OBJECTIVE
  To determine whether attitudes towards highly active antiretroviral therapy (HAART) are associated with unprotected anal sex among sexually active homosexual men.
  
  
  METHODS
  Cross-sectional study nested within an ongoing prospective cohort study.
  
  
  METHODS
  Multicenter AIDS Cohort Study, from April through September 1999.
  
  
  METHODS
  Five-hundred and forty-seven homosexual men reporting anal sex (218 HIV-negative and 329 HIV-positive) during study interviews in 1999, including a 20-item validated scale on attitudes toward HAART and HIV risk behaviors (e.g., 'Because of HAART, I am less concerned about becoming HIV-infected or infecting someone'), and safer sex fatigue (e.g., 'I am tired of always having safer sex').
  
  
  METHODS
  Self-reported unprotected receptive anal sex (RAS) and insertive anal sex (IAS) in the prior 6 months.
  
  
  RESULTS
  More than 50% of HIV-negative and HIV-positive men who reported having anal sex also reported recent unprotected RAS and/or IAS. HIV-negative men who most agreed that HAART reduced concern about becoming infected were more likely to report unprotected RAS compared to other HIV-negative men [adjusted odds ratio (AOR), 3.31; 95% confidence interval (CI), 1.27-8.62]. Moreover, HIV-positive men with greatest reduced concern due to HAART or safer sex fatigue were more likely to report unprotected IAS (AOR, 6.05; 95% CI, 2.24-16.63 and AOR, 4.57; 95% CI, 1.70-12.24, respectively) compared to other HIV-positive men.
  
  
  CONCLUSIONS
  Among sexually active homosexual men, lessened concern about HIV transmission due to HAART was strongly associated with sexual risk taking, as was safer sex fatigue among HIV-positive men. Prevention programs should take into account underlying attitudes for unprotected sex in the era of HAART among both HIV-infected and uninfected men.
authors.affiliation: Loyola University School of Medicine, Maywood, Illinois, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Ostrow
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Fox
authors.forename: Joan S
authors.initials: JS
authors.lastname: Chmiel
authors.forename: Anthony
authors.initials: A
authors.lastname: Silvestre
authors.forename: Barbara R
authors.initials: BR
authors.lastname: Visscher
authors.forename: Peter A
authors.initials: PA
authors.lastname: Vanable
authors.forename: Lisa P
authors.initials: LP
authors.lastname: Jacobson
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000523:psychology* / Q000821:virology; D007722:Health Knowledge, Attitudes, Practice; D006716:Homosexuality / Q000523:psychology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D019562:Viral Load