The perception of having adverse side-effects due to one’s HAART regime was the strongest single predictor of unsafe sexual behaviour among a cohort of French intravenous drug users, according to a study published in the June 15th edition of AIDS.
Patients reporting more than three HAART-related ‘symptoms’ (excluding lipodystrophy) at a clinic visit were 76% more likely to report also having had unprotected sex in the previous six months when compared with those reporting fewer symptoms.
These results come from statistical analysis of the MANIF-2000 cohort, a prospectively-studied group of 467 patients attending three hospitals in southern France and Monaco who had become HIV-positive through sharing needles.
Data were collected between July 1995 and February 2003. Of the 467 patients, 305 were ever treated with HAART; socio-behavioural data were collected for 259 of these; and 192 of them reported having sex with people who were not their main partner (monogamous people being excluded from this study).
Of the 192, 70% reported having had unprotected sex on at least one occasion. The 192 patients made a total of 464 clinic visits; unprotected sex was reported on 54% of these visits.
During the four weeks preceding each visit, the patients filled in a questionnaire asking whether they had any of 14 symptoms of HAART side-effects. The study investigators do not state what these 14 symptom categories were; but they do say the list was “established on the basis of the various side-effects (excluding lipodystrophy) reported in the literature about HAART regimens.”
On multivariate analysis, reporting three or more self-perceived HAART-related side-effects was the strongest single predictor of unprotected sex, with an odds ratio of 1.76 (confidence interval 1.19 - 2.55).
The only other factor showing a significant association with unprotected sex was having two or more partners, but these patients were only half as likely to report unprotected sex (odds ratio 0.51, CI 0.27 - 0.95). This implies that people with many partners were more conscientious about condom use; it was those who only occasionally strayed from monogamy or celibacy who took risks.
Being female (27% of the cohort) was also associated with unprotected sex. Although this result did not achieve statistical significance, women were 1.59 times more likely to report unprotected sex than men.
Patients who were currently using drugs intravenously were also more likely to report unprotected sex, though people on methadone maintenance did not. Once current i.v. drug use was removed as a factor, patients who reported being depressed were 1.6 times more likely to report unprotected sex, but this adjustment did not change the association with reported HAART side effects.
A previous French study of HIV-positive patients in general (Desquilbet) had reported that having depression or signs of lipodystrophy were both independently associated with risky sexual behaviour, although in this case having multiple partners was also a predictor of it.
The new study has limitations, acknowledged by the authors. What was being measured was not clinical symptoms of drug side-effects but the patients’ perception that they had side-effects, and it is possible that depressed people were more likely to perceive that their HAART regimens were making them feel ill.
However, the authors feel justified in saying that among this cohort of current or former intravenous drug users, “the subjective perception of HAART-related side effects may induce a psychological distress that can itself lead to risk-taking sexual behaviours.”
References
Vincent E et al. Impact of HAART-related side-effects on unsafe sexual behaviours in HIV-infected injecting drug users: 7-year follow-up. AIDS 18(9):1321-1325, 2004.
Desquilbet L et al. Increase in at-risk sexual behaviour among HIV-1-infected patients followed in the French PRIMO cohort. AIDS 16(17):2329-33, 2003.