Treatment Optimism-related Risk Behavior in Men Who Have Sex With Men

Treatment Optimism-related Risk Behavior in Men Who Have Sex With Men

Abstract and Introduction

Abstract

Sustainable behavior change among men who have sex with men (MSM) may be threatened by optimistic beliefs about HIV treatments: treatment optimism has been associated with high risk sexual behaviors. We used data from behavioral surveys of MSM attending gay bars in 11 states from 2000-2001 to describe the prevalence and correlates of being less careful with sex or drugs because of treatment optimism (optimism-related risk behavior). Fifteen percent of 1477 HIV-negative or -untested MSM reported optimism-related risk behavior. Optimism-related risk behavior was reported more often by Black and Hispanic MSM (versus white), more often by MSM with a high school education or less (versus college), and less often by MSM in some states. HIV prevention programs should address treatment optimism and related behavioral risks by providing culturally appropriate information, accessible to MSM with lower educational attainment, about the limitations of current therapies.

Introduction

New challenges to HIV prevention have arisen since the availability of highly active antiretroviral therapy (HAART) and associated improvements in control of viral load and survival (Wolitski, Valdiserri, Denning, & Levine, 2001; Valdiserri, 2004). Recent outbreaks of sexually transmitted diseases among MSM in several US cities (Williams et al., 1999; Fox et al., 2001; Chen, Kodagoda, Lawrence, & Kerndt, 2002; CDC, 2002; Ciesielski, 2003) and information gathered from behavioral surveys (Wolitski et al., 2001; Elford, Bolding, & Sherr, 2002; Ciesielski, 2003) indicate increases in sexual behaviors which place MSM at risk for HIV infection. Annual new diagnoses of HIV infections among MSM have increased each year since 2000 in 33 US states with confidential name-based HIV infection reporting systems(CDC, 2004a).

The reasons for increased risk behaviors among MSM are not clear, are certainly complex, and are likely multifactorial. Beliefs about HIV, specifically beliefs about susceptibility to infection (Halkitis, Zade, Shrem, & Marmor, 2004) and severity of HIV infection (Morin et al., 2003), may predict the adoption of preventive behaviors. In the HIV epidemic, the period since the advent of HAART has been marked by changes in beliefs within the gay community that bear directly on these two component beliefs (Valdiserri, 2004). For example, men may believe that HAART reduces the likelihood that an HIV-infected sex partner will transmit HIV, or may believe that the severity of HIV infection is less because of the availability of HAART.

Optimistic beliefs based on the availability of HAART have been associated with high risk sex behaviors in many studies (Kelly,Hoffman, Rompa, & Gray, 1998; Remien, Wagner, Carballo-Dieguez, & Dolezal, 1998; Kalichman, Nachimson, Cherry, & Williams, 1998; Vanable, Ostrow, McKirnan, Taywaditep, & Hope, 2000; Huebner & Gerend, 2001; Ostrow et al., 2002; Elford et al., 2002; Van de Ven et al., 2002; International Collaboration on HIV Optimism, 2003; Williamson & Hart, 2004; Huebner, Rebchook, & Kegeles, 2004; Stolte, Dukers, Geskus, Coutinho, & de Wit, 2004), and these associations have reported to be significant in a recent meta-analysis (Crepaz, Hart, & Marks, 2004). Thus, treatment optimism is related directly to HIV acquisition behaviors, and understanding risk behaviors associated with treatment optimism is of interest in planning prevention programs for MSM.

We used data from a series of behavioral surveys of MSM conducted in 2000 and 2001 in 27 US cities to evaluate the prevalence of being less careful with sex and drugs because of the availability of HAART (optimism-related risk behavior), and to describe demographic factors associated with optimism-related risk behavior.