title: Is use of antiretroviral therapy among homosexual men associated with increased risk of transmission of HIV infection?
abstract: OBJECTIVE
  There is concern that use of highly active antiretroviral therapy (HAART) may be linked to increased sexual risk behaviour among homosexual men. We investigated sexual risk behaviour in HIV positive homosexual men and the relation between use of HAART and risk of HIV transmission.
  
  
  METHODS
  A cross sectional study of 420 HIV positive homosexual men attending a London outpatient clinic. Individual data were collected from computer assisted self interview, STI screening, and clinical and laboratory databases.
  
  
  RESULTS
  Among all men, sexual behaviour associated with a high risk of HIV transmission was commonly reported. The most frequently reported type of partnership was casual partners only, and 22% reported unprotected anal intercourse with one or more new partners in the past month. Analysis of crude data showed that men on HAART had fewer sexual partners (median 9 versus 20, p=0.28), less unprotected anal intercourse (for example, 36% versus 27% had insertive unprotected anal intercourse with a new partner in the past year, p=0.03) and fewer acute sexually transmitted infections (33% versus 19%, p=0.004 in the past 12 months) than men not on HAART. Self assessed health status was similar between the two groups: 72% on HAART and 75% not on HAART rated their health as very or fairly good, (p=0.55). In multivariate analysis, differences in sexual risk behaviour between men on HAART and men not on HAART were attenuated by adjustment for age, time since HIV infection. CD4 count and self assessed health status.
  
  
  CONCLUSIONS
  HIV positive homosexual men attending a London outpatient clinic commonly reported sexual behaviour with a high risk of HIV transmission. However, behavioural and clinical risk factors for HIV transmission were consistently lower in men on HAART than men not on HAART. Although use of HAART by homosexual men with generally good health is not associated with higher risk behaviours, effective risk reduction interventions targeting known HIV positive homosexual men are still urgently needed.
authors.affiliation: Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, Mortimer Market Centre, off Capper Street, London WC1E 6AU, UK. jstephenson@gum.ucl.ac.uk
authors.forename: J M
authors.initials: JM
authors.lastname: Stephenson
authors.forename: J
authors.initials: J
authors.lastname: Imrie
authors.forename: M M D
authors.initials: MM
authors.lastname: Davis
authors.forename: C
authors.initials: C
authors.lastname: Mercer
authors.forename: S
authors.initials: S
authors.lastname: Black
authors.forename: A J
authors.initials: AJ
authors.lastname: Copas
authors.forename: G J
authors.initials: GJ
authors.lastname: Hart
authors.forename: O R
authors.initials: OR
authors.lastname: Davidson
authors.forename: I G
authors.initials: IG
authors.lastname: Williams
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology / Q000635:transmission; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012309:Risk-Taking; D021841:Safe Sex / Q000523:psychology*; D012747:Sexual Partners; D019562:Viral Load