title: Unsafe Sexual Behavior Among Gay/Bisexual Men in the Era of Combination Antiretroviral Therapy (cART).
abstract: The aim of this study was to determine the association between psychosocial determinants of unprotected receptive anal intercourse (URAI) and unprotected insertive anal intercourse (UIAI). Data from 417 HIV positive men who have sex with men (MSM) in the Multicenter AIDS Cohort Study from April 1999 to March 2012 were analyzed and adjusted odds were calculated. It was found that 66% (n = 277) and 72% (n = 299) reported any UIAI or URAI over follow-up, respectively. Cumulative cART-years (median = 5.30 years) was associated with 33 and 47% increases in UIAI and URAI, respectively. Not having reduced concern about HIV transmission (UIAI: OR 0.37, p-value = 0.0004; URAI: OR 0.57, p-value = 0.04), increased safe sex fatigue (UIAI: OR 2.32, 95% p-value = 0.0002; URAI: OR 1.94, p-value = 0.003), and sexual sensation seeking (UIAI: OR 1.76, p-value = 0.002; URAI: OR 1.56, p-value = 0.02) were associated with UIAI and URAI. Serosorting was associated with UIAI (OR 6.11, p-value < 0.0001) and URAI (OR 6.80, p-value < 0.0001). Findings suggest that negative attitudes about HIV transmission are sustained among older men who have sex with men.
authors.affiliation: Social and Behavioral Intervention Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Room E5523, Baltimore, MD, 21205-2179, USA. psurkan@jhu.edu.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Surkan
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Lisa P
authors.initials: LP
authors.lastname: Jacobson
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Cox
authors.affiliation: Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Silvestre
authors.affiliation: Division of Infectious Diseases, Department of Epidemiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Pamina
authors.initials: P
authors.lastname: Gorbach
authors.affiliation: Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Teplin
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Plankey
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001727:Bisexuality / Q000523:psychology*; D015331:Cohort Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D021841:Safe Sex / Q000523:psychology; D012725:Sexual Behavior / Q000523:psychology*; D012747:Sexual Partners / Q000523:psychology; D000072339:Sexual and Gender Minorities; D011795:Surveys and Questionnaires; D047568:Unsafe Sex / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Anti-retroviral agents; Cohort study; HIV; Homosexuality; Male; Sexual behavior