Sexually transmitted infections epidemiology

Gay men with AIDS in Los Angeles having more unprotected sex

Michael Carter
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The sexual risk-taking behaviour of gay men with AIDS in Los Angeles has changed dramatically in recent years, according to a small study published in the February 1st edition of the Journal of Acquired Immune Deficiency Syndromes. This is the latest of several US studies (see links below) to report significant changes in sexual behaviours since the advent of HAART.

Investigators from the Supplement to HIV/AIDS Surveillance Project (SHAS) study recruited 568 gay men diagnosed with AIDS to a cross-sectional population-based study that looked at their sexual risk behaviour. Between 1998 and 2003 the men completed a questionnaire reporting on the number of sexual partners they had had in the previous twelve months. From 2000, individuals were also asked to report if they had had unprotected anal sex with their last sexual partner.

Between 1998 and 2000 the number of men reporting ten or more sexual partners in a twelve-month period remained stable at between 8% - 10%, but increased significantly to 25% in 2003 (p=0.00005).

Glossary

fatigue

Tiredness, often severe (exhaustion).

 

safer sex

Sex in which the risk of HIV and STI transmission is reduced or is minimal. Describing this as ‘safer’ rather than ‘safe’ sex reflects the fact that some safer sex practices do not completely eliminate transmission risks. In the past, ‘safer sex’ primarily referred to the use of condoms during penetrative sex, as well as being sexual in non-penetrative ways. Modern definitions should also include the use of PrEP and the HIV-positive partner having an undetectable viral load. However, some people do continue to use the term as a synonym for condom use.

syphilis

A sexually transmitted infection caused by the bacterium Treponema pallidum. Transmission can occur by direct contact with a syphilis sore during vaginal, anal, or oral sex. Sores may be found around the penis, vagina, or anus, or in the rectum, on the lips, or in the mouth, but syphilis is often asymptomatic. It can spread from an infected mother to her unborn baby.

sample size

A study has adequate statistical power if it can reliably detect a clinically important difference (i.e. between two treatments) if a difference actually exists. If a study is under-powered, there are not enough people taking part and the study may not tell us whether one treatment is better than the other.

sample

Studies aim to give information that will be applicable to a large group of people (e.g. adults with diagnosed HIV in the UK). Because it is impractical to conduct a study with such a large group, only a sub-group (a sample) takes part in a study. This isn’t a problem as long as the characteristics of the sample are similar to those of the wider group (e.g. in terms of age, gender, CD4 count and years since diagnosis).

In 2000, 11% of individuals reported unprotected anal sex with their last partner, increasing to 26% in 2003. Because of the small sample size, investigators were not able to analyse these data for statistical significance.

”Although these data are limited to sexually active [men who have sex with men] diagnosed with AIDS, these findings…are consistent with the recent increase in reported syphilis” amongst gay men in Los Angeles, note the investigators, who also observe that 50% of syphilis cases in 1999 involved HIV-positive gay men.

These data suggest to the investigators that “sexual risk behaviours are continuing to increase in HIV-infected” gay men. This could be due to “safer sex fatigue”, increased sexual activity thanks to the health-improving effects of HAART, or a belief that HAART makes HIV less serious. Urgent individual and community-based HIV prevention efforts are needed, conclude the investigators.

Further information on this website

Saunas and drugs linked with rectal gonorrhoea in gay men in San Francisco study - news story

The dark side of HAART optimism? More unsafe sex and poor adherence - news story

Safer sex fatigue and HAART optimism explain rise in US bareback sex - news story

Sexual health - factsheets

References

Wohl AR et al. Recent increase in high-risk sexual behaviors among sexually active men who have sex with men living with AIDS in Los Angeles county. JAIDS 35: 209 – 210, 2004.

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