title: Association between 'safer sex fatigue' and rectal gonorrhea is mediated by unsafe sex with casual partners among HIV-positive homosexual men.
abstract: OBJECTIVE
  The objective of this study was to investigate whether and what sexual risk behavior is a mediator of associations between rectal gonorrhea (RG) and highly active antiretroviral therapy-related beliefs, safer sex fatigue, or sexual sensation-seeking among homosexual men.
  
  
  METHODS
  This study consisted of a cross-sectional survey between March 2002 and December 2003 among homosexual visitors of the Amsterdam sexually transmitted disease clinic.
  
  
  METHODS
  In total, 1568 men answered a written questionnaire. Associations were determined using logistic regression corrected for repeated measurements.
  
  
  RESULTS
  The RG infection rate was high among homosexual men who were HIV-positive (16%) compared with those with negative or unknown HIV status. Mediation could be confirmed among HIV-positive men only. Those who experienced higher levels of safer sex fatigue were more likely to be positive for RG. This association was mediated by unprotected anal intercourse (UAI) with casual partners.
  
  
  CONCLUSIONS
  Addressing safer sex fatigue might help prevent UAI with casual partners and possibly also RG among HIV-positive homosexual men.
authors.affiliation: Cluster of Infectious Diseases, HIV & STD Research, Municipal Health Service, Amsterdam, and the Department of Social and Organizational Psychology, University of Utrecht, Utrecht, The Netherlands. istolte@gggd.amsterdam.nl
authors.forename: Ineke G
authors.initials: IG
authors.lastname: Stolte
authors.forename: John B F
authors.initials: JB
authors.lastname: de Wit
authors.forename: Marion
authors.initials: M
authors.lastname: Kolader
authors.forename: Han
authors.initials: H
authors.lastname: Fennema
authors.forename: Roel A
authors.initials: RA
authors.lastname: Coutinho
authors.forename: Nicole H T M
authors.initials: NH
authors.lastname: Dukers
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D006069:Gonorrhea / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control* / Q000635:transmission; D015658:HIV Infections; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012309:Risk-Taking; D021841:Safe Sex / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires