AIDS complacency leads back to risky behavior
Latest research shows trend toward unsafe sex
Southern California researchers went into the heart of the gay community in West Hollywood and interviewed more than 600 men about their sexual practices and their attitudes towards HIV and AIDS. Their findings mirrored what many AIDS groups had been saying about how gay men have become more complacent about the disease and increasingly are returning to high-risk sexual behaviors.
The survey also showed that one of the main reasons gay men are becoming complacent about the disease is because of the success of protease inhibitors, says Sheila Murphy, PhD, professor at the Annenberg School for Communications at the University of Southern California in Los Angeles.
The study, which was presented at the first National HIV Prevention Conference, held Aug. 29-Sept. 1 in Atlanta, underscores how important it is for clinicians to continually educate HIV patients about why they must take safe sex precautions even while taking highly active antire troviral therapy (HAART), Murphy says.
Funded by the Atlanta-based Centers for Dis ease Control and Prevention, the study showed a correlation between men who engaged in risky sex and men who were optimistic about protease inhibitors stopping HIV.
"Anecdotal evidence supports this; men who think AIDS is over will say, I don’t have to worry about HIV anymore because there’s this drug out there,’" Murphy says.
Men who reported having HIV showed an even stronger correlation between having risky sex and believing new HIV drugs have brought the disease under control. "Because of the drugs, they were less fearful of transmitting HIV to someone else, and they thought if they gave it to someone else, it’s less bad because of the drugs," Murphy explains.
Prevention must be made top priority
While the survey’s findings are no surprise to leaders of advocacy groups, like Daniel Zingale, executive director of AIDS Action in Washington, DC, the findings do show that the U.S. government should make HIV prevention a much bigger priority than it has been.
"For the past four years, there have been no new federal investments or initiatives for HIV prevention," Zingale states. "And it’s certainly clear that we need to design new strategies of HIV prevention, because we’re dealing with a longer-term challenge now that people, fortunately, are living longer with HIV."
The survey also shows that clinicians have good reason to fear that drug-resistant HIV will continue to spread as people on HAART spread their virus to uninfected partners.
Some HIV patients are confused by the term "undetectable levels." They might think, erroneously, that this means they no longer are contagious. Adding to the problem is that clinicians may find this issue confusing, as well, Murphy says.
"Are you less contagious if you have less HIV in your blood, and doctors think theoretically this makes some sense, and that’s the part that causes confusion," she explains.
"However, there seems to be a sense that you can’t transmit it if you have undetectable levels, and that’s clearly a dangerous and unproven belief that probably is not true," she adds.
In the meantime, several studies have been published showing that people with undetectable levels of HIV in their bloodstream sometimes still have detectable levels of HIV in their semen or vaginal fluid, which implies that it could be transmitted to other people.
Murphy says the study also turned up an attitude among gay men of "Don’t ask, don’t tell," when it comes to finding out their own and their partners’ HIV statuses.
"I didn’t present that data at the conference, but they were not asking whether the person they were sleeping with was HIV-positive or -negative," she says. "And the more optimistic you were, the less likely you were to know whether the guy you were having sex with is positive."
Tell patients about HIV resistance problems
In light of the study, it’s extremely important that clinicians give patients a realistic view of their future with HIV.
For one thing, physicians have to emphasize that not everyone can tolerate the antiretroviral drugs. It’s also important to tell patients that the HIV in some people’s bodies can develop resistance to antiretroviral drugs, and that drug-resistant virus can be passed on to new sexual partners, Murphy says.
"They need to be clear that AIDS is not over," she adds. "Doctors have to give patients a sense that the epidemic is not over, so people who are HIV-positive will continue to be responsible for preventing transmission of the disease."
The survey was designed to determine whether optimism regarding antiretroviral drugs containing protease inhibitors is related to increased sexual risk-taking among men who have sex with men. Investigators approached men on the streets of West Hollywood, interviewing 503 men between the ages of 18 and 41, who identified themselves as gay or bisexual and agreed to complete a self-administered survey.
Of the 503 men, 410 had heard of protease inhibitors (83%) and were eligible to answer questions regarding their impact. The survey had five questions designed to measure their level of optimism about the drugs’ impact on the quality of life of HIV-positive men.
Of 346 respondents whose HIV status was negative or unknown, there was a consistent negative correlation between the index of optimism toward drug therapy and their engaging in monogamous sex or percentage of time using condoms during anal sex. A similar negative correlation was found between the 64 HIV-positive respondents’ optimism and use of condoms and monogamy.
The more optimistic HIV-negative men were significantly less likely to use condoms, abstain from anal sex, be in monogamous relationships, limit their number of partners, engage in mu tual masturbation, and know their partner’s HIV status. HIV-positive men who had higher levels of optimism about the drugs also had unprotected sex with a significantly greater number of partners.
The study concludes that the data could be interpreted two ways:
• People who engage in risky sex may attempt to rationalize their behavior through optimism regarding protease inhibitors.
• The introduction of drugs that enhance quality and length of life among HIV-positive individuals may have reduced the overall level of concern people have regarding contracting or transmitting HIV, and this results in riskier sexual behavior.
Advertising is partly to blame
The fact that HIV-infected people are taking prevention efforts less seriously now that protease inhibitors are available is partly the result of drug manufacturers’ advertising efforts, Zingale claims.
Ads for AIDS drugs portray people involved in risky athletic endeavors, illustrating the point that their lives may continue as if they were not infected, Zingale says.
The positive message isn’t lost on young people at risk for the disease. Only instead of climbing cliffs or skydiving, they might instead decide not to use a condom when engaging in sexual intercourse.
"This should be a wake-up call about the issue of raising false expectations around this generation of AIDS drugs," he says. "I believe those false expectations are putting a new generation at risk for HIV."
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