Increases in the proportion of Scottish gay men reporting unprotected sex with casual partners cannot be explained by optimism about HIV, according to a study published in the March 25th edition of AIDS.
HIV optimism (the belief that HIV infection has become a less serious condition as a result of improved treatment) has been suggested as a possible reason for an apparent increase in the amount of unprotected anal intercourse with casual partners reported by gay men in studies in both the US and Europe. Although some studies have found a relationship with HIV optimism and risky behaviour, others have not (see links to two recent news stories reported on aidsmap below).
In 1999 and 2002 investigators questioned a cross-sectional sample of gay men in gay venues in Glasgow and Edinburgh. HIV optimism was assessed by looking at responses to two questions. The first of these questions asked if men were less worried about HIV since improved treatments became available, and the second asked men if they believed anti-HIV treatments made HIV-positive men less infectious.
A total of 2,498 men participated in the survey in 1999 and 1,734 in 2002.
Men who said they “strongly agreed” with either of the statements were classified as optimistic, and men “strongly disagreeing” as not optimistic.
The investigators found that the proportion of men reporting unprotected anal sex with a casual partner increased from 10.5% in 1999 to 18% in 2002 (p<0.001).
There was also an increase in the proportion of men expressing optimism about HIV. In 1999, 13.9% of men strongly agreed that they were less worried about HIV because of new treatments. This increased to 23.2% in 2002 (p<0.001). Similarly, there was an increase in the number of men agreeing that new treatments made men with HIV less infectious. The proportion of men strongly agreeing with this increased from 7.6% in 1999 to 12.5% in 2002 (p<0.001).
Further, men providing optimistic responses to the two statements were more likely to reported unprotected sex with casual partners (19.6% versus 12.8%, p<0.001) question one, and 21.1% versus 13.2%, p<0.001, question two).
Unadjusted odds for unprotected sex with casual partners were higher in 2002 than 1999. In multivariate analysis, although both survey year and HIV optimism remained significant predictors for unprotected sex, there was no significant interaction between the two (p=0.7).
The investigators repeated their analysis separately for men who had tested for HIV and men who had not. The investigators found that only the survey year remained significant (p<0.001). Therefore, even though the percentage of never-tested men reporting unprotected sex increased between 1999 and 2002, the rate of increase was greater amongst men who were not optimistic.
The investigators comment that although men who were optimistic about HIV were more likely to report unprotected sex, both the year of survey and HIV optimism were “significantly and independently associated with sexual risk in multivariate analysis”. The investigators further explain, “If HIV optimism alone explained the increase in sexual risk, either the year of survey would not have remained significant or there would have been a significant interaction between year and optimism. In fact, the survey year remained significant after controlling for optimism.”
“Our results strongly suggest that HIV optimism cannot explain the recent increase in high-risk sexual behaviour among Scottish gay men,” conclude the investigators, who recommend that urgent attention be given to the identification of other factors associated with risky sex.
Further information on this website
Gay men realistic, not optimistic about HAART says study - news story
The dark side of HAART optimism? More unsafe sex and poor adherence - news story
Williamson LM et al. HIV optimism does not explain increases in high-risk sexual behaviour among gay men in Scotland. AIDS 18: 834-845, 2004.