Gay men are “realistic rather than optimistic” about anti-HIV treatments, according to a multinational study into HIV treatment optimism amongst gay men published in the April 15th 2003 edition of the Journal of Acquired Immune Deficiency Syndromes.
It has recently been suggested that the success of HAART at reducing the incidence of illness and death had led to gay men in western industrialised countries becoming complacent about the risk of HIV and therefore more likely to have unprotected sex. There are conflicting data on the HIV risk behaviour of gay men since HAART, which this study adds to.
In 2000 investigators from the UK, France, Canada and Australia collaborated on a research project into the HIV optimism of gay men. The study was designed to establish if gay men were optimistic in the light of new HIV treatments; if the level of optimism varied between communities; and if there was an association between optimism about HIV and sexual risk behaviour.
The study involved self-completed questionnaires, although their distribution varied between countries.
Questions in the survey relating to HIV optimism were designed to establish if gay men perceived HIV as a less serious infection because of HAART, and if they thought that, as HAART reduces viral load, it made HIV less infectious. Men participating in the survey were asked to strongly agree; agree; disagree; or, strongly disagree with four statements, with their answers scored on a four-point scale ranging from 1 for strongly disagree to four, strongly agree.
- New HIV treatments will take the worry out of sex.
- If every HIV-positive person took the new treatments, the AIDS epidemic would be over.
- People with an undetectable viral load don't need to worry so much about infecting others with HIV.
- HIV/AIDS is a less serious threat than it used to be because of new treatments.
As regards sexual behaviour, men were asked if they had had unprotected anal sex over a range of time periods, which varied between study cities. Men who said that they had had unprotected anal sex were then asked if this was with a casual or regular partner. Men who had unprotected anal sex with casual partners were considered to be at high risk of HIV and were compared to men reporting no unprotected anal sex, who were assessed as having a low or no HIV risk.
The investigators analysed the responses of 5,882 men. Average age was 36 years, most men were in employment and around 50% were in a relationship. The proportion of men reporting ever had an HIV test varied widely between the study with 21.1% of men in London saying they had never tested, and only 1.4% in Vancouver. Approximately 20% of men had been treated for a sexually transmitted infection in the period covered by the study questionnaire and the percentage of men who were HIV-positive ranged between 16.7% in London and 4.8% in Vancouver. The proportion of men reporting unprotected anal sex with a casual partner also varied between cities, from a high of 22.6% in Vancouver to 15.3% in London. The number of men reporting anal sex without condoms with their partner also varied between cities, from almost 40% in Vancouver to 17.6% in London and Paris.
Investigators found that most men either disagreed or strongly disagreed with the questions designed to assess HIV optimism and were broadly comparable between the study cities. No more than 20% of men in any city agreed with any of the HIV optimism statements.
Average optimism scores were lowest in Paris and highest in Vancouver, however the difference was only 1.7 points. In all cities except Vancouver, men having unprotected anal sex with casual partner were more optimistic.
The investigators note that despite the availability of HAART for four years before the study was conducted and the dramatic drop in HIV-related illness and death “only a few men expressed ‘HIV optimism.’ Far from being optimistic, most gay men appeared realistic about the benefits of these drugs.”
No consistent relationship was found between optimism and HIV status across the study cities, “highlighting the heterogeneous nature of gay men’s response to new therapies.” However, HIV-positive men in Vancouver were the most optimistic and those in Paris least optimistic. The lack of optimism amongst Parisian gay men was attributed by the investigators to information in the local gay press about the reality of HIV treatments and that the French survey was distributed via the gay press. However, although not acknowledged by the authors, the UK gay press at this time included extensive coverage and advertising campaigns on HIV prevention and treatment issues, which emphasised that HAART was not a cure for HIV; that HAART had side-effects; and, that a person taking HAART was still, potentially, infectious.
As regards optimism and unprotected sex, the investigators found that men who were more optimistic were more likely to have unprotected sex with casual partners. However, they could not determine if optimism triggered higher risk behaviour or if men who admitted unprotected sex used optimism as an excuse to rationalise their behaviour.
The investigators conclude that gay men were being realistic rather than optimistic about HAART and that there was no single response to HAART across the study cities.
Further information on this website
Sexual health - factsheets
Both older and younger gay men having more unprotected sex in San Francisco - news story
Older gay men with STIs at greatest risk of HIV - news story
San Francisco HIV prevention campaign highlights side-effects - news story
HIV incidence increasing most rapidly amongst older gay men in Amsterdam - news story
High risk pool of gay men with multiple partners growing in the UK - news story
The dark-side of HAART optimism? More unsafe sex and poor adherence - news story
City University and Royal Free and University College Medical School, London and other research centres. HIV treatments optimism among gay men: an international perspective JAIDS, 32: 545 – 550, 2003.