Attitudes towards highly active antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men.
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.
Ostrow
David E
DE
Loyola University School of Medicine, Maywood, Illinois, USA.
Fox
Kelly J
KJ
Chmiel
Joan S
JS
Silvestre
Anthony
A
Visscher
Barbara R
BR
Vanable
Peter A
PA
Jacobson
Lisa P
LP
Strathdee
Steffanie A
SA
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