Safer sex fatigue and HAART optimism explain rise in US bareback sex

The success of HAART and boredom with safer sex mean that American gay men with HIV

are more likely to have unprotected anal sex.

Data gathered from 1156 gay men in 1999 in Baltimore, Chicago, Los Angeles

and Pittsburgh, as part of the Multicenter AIDS Cohort Study showed that

nearly 53 per cent (611) had had insertive or receptive anal sex without a

condom in the past six months. Of these men, 547 completed a 20-item survey which

asked about personal attitudes towards HAART and risk behaviour, drug and

alcohol use during sex, safer sex fatigue, beliefs about the infectivity of

those taking HAART, and sensation seeking. Answers were graded on a five

point scale.

Amongst the 329 HIV-positive men completing the survey, reduced HIV concern,

use of drugs and alcohol, boredom with condoms, beliefs about their

infectivity, and sensation seeking were all significantly associated with

the likelihood of having unprotected insertive anal sex. HIV-positive men with

reduced concerns about the seriousness of HIV infection were six times more likely to have unprotected

insertive sex. In addition, researchers also noted that knowing that a

partner was also HIV-positive increased the chances of having insertive anal

sex without a condom "perhaps under the assumption that re-infection is not

a health risk."

However, contrary to the expectations of the research team, HIV-positive men

experiencing a fall in viral load to below 400 copies m/L were slightly less

likely to have either insertive or receptive anal sex without a condom. This

adds to a body of conflicting research, with an earlier American study

suggesting that an undetectable viral load was not associated with an

increased propensity to unprotected insertive anal sex, whilst a Dutch study

suggested the opposite.

Of the 218 HIV-negative men in the study, the main factor associated with

having receptive anal sex without a condom was, unsurprisingly, having a regular partner,

with unprotected sex with a casual partner being reported much more rarely.

Reduced concern about the seriousness of HIV infection was also associated with unprotected receptive anal sex in HIV-negative men, and those

declaring themselves as having `safer sex fatigue` were over twice as likely

to have had sex without a condom. `Safer sex fatigue` was identified by answers to the question "I feel tired of always having to monitor my sexual behavior".