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".
References
Ostrow DE et al. Attitudes towards highly active antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men AIDS 16: 775-780, 2002.
Dukers N et al, Sexual risk behaviour relates to virological and immunological improvements during highly active antiretroviral therapy in HIV-infection. AIDS 15: 1-10, 2001.
Vanable PN et al. A preliminary study of the effect of viral load on sexual risk taking among HIV-positive gay men. Annual Meeting of the Society of Behavioural Medicine, Nashville, March 2000