Key points are not available for this paper at this time.
Objective To determine whether attitudes towards highly active antiretroviral therapy (HAART) are associated with unprotected anal sex among sexually active homosexual men. Design Cross-sectional study nested within an ongoing prospective cohort study. Setting Multicenter AIDS Cohort Study, from April through September 1999. Participants Five-hundred and forty-seven homosexual men reporting anal sex (218 HIV-negative and 329 HIV-positive) during study interviews in 1999, including a 20-item validated scale on attitudes toward HAART and HIV risk behaviors (e.g., ‘Because of HAART, I am less concerned about becoming HIV-infected or infecting someone'), and safer sex fatigue (e.g., ‘I am tired of always having safer sex'). Main outcome measures Self-reported unprotected receptive anal sex (RAS) and insertive anal sex (IAS) in the prior 6 months. Results More than 50% of HIV-negative and HIV-positive men who reported having anal sex also reported recent unprotected RAS and/or IAS. HIV-negative men who most agreed that HAART reduced concern about becoming infected were more likely to report unprotected RAS compared to other HIV-negative men adjusted odds ratio (AOR), 3.31; 95% confidence interval (CI), 1.27–8.62. Moreover, HIV-positive men with greatest reduced concern due to HAART or safer sex fatigue were more likely to report unprotected IAS (AOR, 6.05; 95% CI, 2.24–16.63 and AOR, 4.57; 95% CI, 1.70–12.24, respectively) compared to other HIV-positive men. Conclusions Among sexually active homosexual men, lessened concern about HIV transmission due to HAART was strongly associated with sexual risk taking, as was safer sex fatigue among HIV-positive men. Prevention programs should take into account underlying attitudes for unprotected sex in the era of HAART among both HIV-infected and uninfected men.
Ostrow et al. (Fri,) studied this question.